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l FOR OFFICE USE: ' APPLICATION FOR SANITATION PERMIT --------------- ---- - 11= -- ------ - -- Permit No: `- . _ -' a (Complete in Triplicate} --- -' c -- - _' �- 7 7l 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/LOCATIO�yN�.�----- - - -�. . -------------------------- -- --Gdf__----I _--Lv�j-�--- --- -C - `Y------W- NSUS TRACT -------------------------- Owner's N //1 " -----•------- --------(r.- !�� i --- ----------=-•--------- - Phone -------:------------------------=--- ress Cont actor' s f "f-, -` City71-W-1-1, t --------------------- r - Name - IS _ -----------------------------License #�7_ ,.$_�{_3_._ Phone '` Installation will serve: Residence [Apartment House,E] Commercial ❑Trailer Court !❑ a I Motel ❑ Other --------------------------------- f Number of living units:___!.-._-- Number of bedrooms -3_.-____Garbage Grinder _?�q----- Lot Size ____________________ Water Supply: Public System and name -------------------------------------------------=--=----------------------------------------------------------Private Character of soil to a depth of 3 feet:-,_Sand,'❑„Sift,❑„ Clay eat❑ Sandy Loam •Q ` Clay Loam ❑ :Hardpan ❑ Adobe'❑ Fill Material ------------ If yes, type ---------------------------- (Plot plan, showing size of lot, to Cation 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,) �c mDSize f A PACAGE TREATMENT [ iPTICK [ S - '� ------------------- --------------- Capacity JL Liquid Depth .- Cp Y - -----q&aType _ Material . No. Compartments -- ____..._.:._ . Distance to nearest: Well ------7p_"--_____________�___Foundation _.�P___`---------- Prop. Line _�-a,-__________ } LEACHING LINE [� No. o{ Lines "____._ Length f ` ----------------- Len th ach line Total Length _/S-o-----t-1. KI ., . 'D' Box _ .S._ Type Filter Material _____ -_______ __Depth Filter Material __/ . E Distance to nearest: Well /d0---- --------- Foundation Foundation tA?-----_-f_------- Property Line _______________ SEEPAGE PIT [j+— Depth --- ._�_�_ _ Diameter _--________-r Number u_ ~....._. Rock Filled Yes � No C]� 3.� Water Table 'Depth -------------------------N -------------Rock Size --•------------ --------------- Distance to nearest: Well ----------------------------------------Foundation ---------------- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# ________----------------------------------- Date -------------------k-------------- Septic _____________} Se tic Tank (Specify Requirements) -- t �- 4 y Disposal Field (Specify Requirements) ----------- ---------------------------- _ -------------_--------.:---------------------------------" = ----------------------------- --------------------------------------------- --------------------------------------------------------------------------------------------------- ----------------- --------- ----------------------------------- --------------- (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 San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the foilowing: "I certify that in the performance ofithe work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's.Compensation laws of California." Signed ------. ----------------- - ------------------------------------------------- Owner �p - - ---- BY [-- ------- -- Title . (If other than owner) FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ ------- (J_r -fW------ --------------------------------- DATE = .----- BUILDING PERMIT ISSUED ------ ------ r ------- -DATE ---------------------------- ------ ADDITIONAL COMMENTS a - L ------- rt'-1 ------------------------- ---------------------- ----------------- --------- --- -------------------------I----------------- -------------- ------------------- ------------------------------------------------------------------------------------- Inspection by: - Date ----------- Final --� --- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M