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` , FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicated Permit No. _--7 __S&_S This Permit Expires 1 Year From Date Issued Date Issued ----------------------------------------- -------- ------ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ----LFII/�, __ --- .------- �t�---CENSUS TRACT -------------- ----------- Owner's Name J001- 4—c tn.[----(r(�_t.t_ .. - Phone / ---�/! _ ------------------ Address ��- 9 ---� �1,cG� LL _ � c E� - - - ------ . City -4-04I - - - Contractor's Name -__C ,"f��7ix�, - caca__ �___ � ____---.License # �_7_. Phone1'� Installation will serve: Residence ❑ Apartme ouse-❑ Commercialailer Court ;❑ Motel ❑ Other - _-___________________ Number of living units------------- Number of bedrooms ____________Garbage Grinder ------------ Lot Size --_---_-____-_____________-_______________ Water Supply: Public System and name -------------------------------------------------------------------------------------------------------------.Private k` Character of soil to a depth of 3 feet: Sand'❑ Silt 0 Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type _____-__--________-_____-- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,] J PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size------------------------------------------------ Liquid Depth --------------------------- 6445 o1% Capacity -------------------- Type -------------------- Material---------------------- No. Compartments ---------------------- ff ll Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ----____------------_. LEACHING LINE [ ] No. of Lines ___ g g f ______ Len th of each line._____ _ - - -------- Total Length ___ " _______________ jj � / A 'D' Box _(f(-j70_ Type Filter Material �__- X_ f _Depth Filter Material __-/ _________________________________ Distance to nearest: Well _/.S`O____--------- Foundation .../_F2--------------- Property Line rr �, �� SEEPAGE PIT [ ] Depth - _-____ Diameter _ _--_ Number ---------l---------------- Rock Filled Yes 1�C1 Water Table Depth -------''`d-f----------------------------Rock Size ----- Distance to nearest: Well -------------------------Foundation ------- Prop. Line _. _._____ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date _________-______--_____________) Septic Tank (Specify Requirements) --------- ------------------------------------------------ P - Disp _sal Field (Specify Requirements) .....__ __--_ � --- --------- ------------------------------ (Draw xisting and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that in the pe ormance of the work for which this permit is issued, I shall not employ any person in such manner as to be4sub* Workman' Comp a on laws of California." igned - r------- --- - --- ---- -- ------ -- --------------- Owner Y ----- --=----------- Title ------ --- ------------------- han owner] FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- ------ ------------------------------- ----- ----- ------------.. DATE -- ��f ----------------- - BUILDING PERMIT ISSUED ----------------- -----------------DATE ------------------------- ---------------- ADDITIONAL COMMENTS ------------------------------------------------------------------------------- -------------------------------------------------- -------------- ------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------ - - - - - - ------------------ - - - ----------------------------------------------------------------------------- Final Inspection by: ---- -------------------------------- --------- -------------------Date - ! SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M