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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permtl No. ..__.. ..y (Complete in Triplicate) }. 7 b This Permit Expires I 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 descri ed. This application is madelin compliance with County Ordinance No. 549 and existing Rules and Regulations: 1 � r ,,, JOB }DORfSS/LOCATION ... / D,S,l• �.... /..COev Xe- Owner's I' d..... . ......... -!�?VY.....CENSUS TRACT .......................... Name ..._. =........,_...................:................Phone ...-............_.._......... Address d5 .J.,......_..f.3 __... ty Contractor's Name --- -A 7-hi��----'t. So./y .............•..........License # Phone . Installation will serve: Residence Pff Apartment House Commercial❑Trailer Court 0 1 Motel ❑Other............. } - Number of living units:... Number of bedrooms 3.....Garbage Grinder ..A!p... Lot Size .. `�.•.--•-••••••••• ---•-•••-• Water Supply: Public System and name .........--........-.....................................__...._._.......-----........._..._..---...........Private K) Character of soil to a depth of 3 feet: Sand l[ Silt❑ Clay ❑ Peat❑ Sandy Loam o Clay Loam ❑ ' Hardpan ❑ Adobe❑ F#II 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 204 feet,) , PACKAGE TREATMENT f ] SEPTIC TANK I )0eiJ Size-_-laad•..........I—......I........ Liquid Depth .......................... Type . Material.---____._•-----...... No. Compartments A.................. Capacity _./ U i . Prop. Line ......................� Distance to nearest: Well .../_ttU.._...................Foundation ..................... LEACHING LINE [ ] No. of Lines ----_--- ...... Length of each line............................ Total Length ............................ 0 'D' Box ------- Type Filter Material ...........Depth Filter Material .......................................... Distance to nearest: Well ---------------= ....... Foundation .---------_-------- Property Line ...................... SEEPAGE PIT ( l Depth --------------- Diameter ................ Number ........................ Rock Filled Yes ❑ No 0 Water Table Depth ------- -----------------------...Rock Size -------------------------------- r Distance to nearest:.Well ...Foundation ............:....... Prop. Line ...................... REPAIR/ADDITION Wrev. Sanitation Permit# ...-..=-•-------•••......................... Date _---------_ .................. r. Septic Tank (Specify Requirements( j -- '•' I� f�.j. - �•`•AV P •�.. T _ Disposal Field {Specify Requirements] .-- --: .........................................................•.................... k --•-------------- --------------------------------------------------- --------------•------ --•------•-----•-..............................•-...............___._.....---......._........................................ (Draw existing 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 Son Joaquin Local Health:District. Home owner or Ilten- . sed agents signature certifies the following: "I certify that in the performance of.the work for which this permit is issued, I shall not employ any person in such manner kas to become subject to Workman's Compensation laws of California." Signed %------- ............ -------------------- Owner By - -------:a-� _-- - - xitle----------------'---------------- ( O' wnerl r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ _---------- ---------- --------- DATE .--- ---- -- •------------ BUILDING PERMIT ISSUED -----_--_-----• -------------------- ----------------DATE -----------..................... ADDITIONALJ CO M NTS ..... = - _... „ cam- - �4 ......._. i --------------------- ------- --------- - - -•-----•-•------•-----•------•---------..._ . ------------------------------------------ ---- -- - -•----- -- ----,................................____-._..-.-_-.---------- ... Final Inspection by: -Date ... ,. .-�. .. _ Eli 13 24 1-58 `-,SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M y a