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k� FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT k ---------,; .------*------------------------------ - Permit No, . (Complete in Triplicate] • --------------------------------------------------- �j Date Issued _._____----.,-_--_--_- This Permit Expires 1 Year From Date Issued Application is hereby made"t6 the San Joaquin bL al HealthiDi`stfict fo—r a permit-to construct and install-the -Work herein described. This application is made in coinpl ante with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION , -_._ `- - ------------ - CENSUS TRACT ` __ _ :__ -�•--�_z�_�x��t ---Phone c'�'`t_.' ------!_-�`�---�--�J----- e ---------- ! ------------------------------------r Owner's Name _�-,wf�--�Q�_�_� �----- ----5---------- nn �7 Address __] - / � .= I4- /,�1 ''i Ci#Y � An p'�------ p g - Contractor's Name --�� ,---.. - 1, `P--------------------------------{----.License - ----- Phone Installation will serve: Residence gApartment House Commercial [:]Trailer Court ;❑ $ Motel Number of living units:---�_.------ Number of bedrooms _____ --____Garbag Other ---------------------------- Z e Grinder ------------ Lot Size -- - +G"/'2� __ "�-----_---- Water Supply: Public System --------------- -------------------------------- ---- -- --------------- ---------�------ _Private ❑ PP Y= Y - - ------+ f Character of soil to a depth of 3 feet: Sand ❑ Silt❑ ;lay ❑ Peat� Sandy Hardpan E] Adobe'❑ Fill Mate ria Loam tg,.. Clay,Loam (7]Il - ------ If yes, type ------- -------------------- a F (Plotlplan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: .(No septic flank or seepage pit permitted if public sewer is available within 200 feet,) 4 I PACKAGE TREATMENT �[•] -SEPTIC TANK'[ ] Size------------------------ f-----'--- -- Liquid Depth -----------'--••---------- V Capacity ------------------ TyJer ------ f------ Material----------- ---- ----- No. Compartments --------------------•- F Distance to nearest: We ------------------------------Found tion ---------------------- Prop. Line ---------- \ LEACHING LINE [ ] No. of Lines -------- -------- ngth of each line--------- ___------_______ Total Length ----_______._.________--- 6\ F t r k 9 4 'D' Box -----"--.-- Type.Filterial ____________________Dept Filter Material ---------------------------------------•- ..,�, Distance to nearest: Well ________________ Foundation -------_______-----___ Property Line, ________________ SEEPAGE PIT [ ] Depth -------- ----------- DiaF_______________ Number _-- ------------------------ Rock Filled Yes ❑ No i❑ fWater Table Depth ____--- _Roc Size ------____.______--___Distance to nearest: Well _ -------------------------Fo ndation ----_.___..___------ Prop. Line _-______..__________--REPAIR/ADDITION(Prev. Sanitation Permit# ------- --------------------------- Da -----------------------------_----) i SepticTank (Specify Requirements) --------------------------------------------------------------------------------- ----- - ---------------------- Disposal Field (Specify Requirements) -----A ----------4T-- ------- ew_ �1.1w�---------1,9WJ---------- r ` — s --- _ �.---------------------------------------------_ - - _ ---------------' (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 licem. 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 as to become subject to Workman's Compensation laws of California." Signed r ---------------------------. Owner -------------------------- Title ---- ------------------- ------------------------------------------------ Sy -------- --- ---- (if other than owner FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - R!V- ---------------------------------------------------------------- DATE ...... BUILDING PERMIT ISSUED ----------------------- ------------------- ---DATE ----------- ------------------------------- - -= , -ADDITIONAL COMMENT ------------ ------------- - ------------- ------- ----- -- -------------------------------------f---7---T---------- = I p-- ------------ -- ------- --------- -- -- Final Inse SAN JOAQUIN LOCAL HEALTH DISTRICT w; E. H. 9 1-'b8 Rev. SM