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"FOR OFFICE USE: 44 APPLICATION FOR SANITATION PERMIT -------------------- --------------------------- -------- (Com lete'in li Tri cate} Permit No. p r ,. This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made tc the San Joaquin Local Health District for a permit to construct and install the work herein F described. This application is mad e+in'co��mplliance with County Ordinance No. 549 and existing Rules and Regulations: JoBr ADDRESS/LOCATION .- -_IJ.S-',I 0 - --------------- ------ -----------CENSllS TRACT -------------- ........... Owner's Name - ?7�',11 ��y---------------------------------------------------------- ------Phone-------------------•-------- Address ------- Gcity = F Contractor's Name - - `--- - ------------------- --------License --------- Phone _ _ _'2_'ff Installation will serve: Residence Apartment House❑ Commercial :❑Trailer Court ;❑ Motel ❑ Other -------- - ------------------------ Number of living units:.__._.__. Number of bedrooms Number Grinder _______,Lot Size ___________________________________________ ' Water Supply: Public System and name _____________ _ ________Private a Character of soil to a depth of 3 feet Sand❑ Silt❑ Clay Peat'❑ Sandy Loam ,E] Clay Loam ❑ Hardpan ❑ Adobe Fill Material ------------ If yes, type ---------------------------- ,a ]Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side.) U4 NEW INSTALLATION: (No septic tank or seepage pit permitted if publics sewer is available within 200 feet,) Q PACKAGE TREATMENT [ ] SEPTIC TANK Size__y_�---' _ =__- 1�__., Liquid Depth __S_- _____ Capacity Z�� _--_---- Type ------ Material�__ ei-E------- No. Compartments _---- -.`........... Ch ---Foundation ---/Q._-___--=---- Prop. Line ---- - -:--•-•--- Distance to nearest: Well --__;_S __________________ _ ! LEACHING LINE [ ] No.' of Lines _______ ____________ Length of each line____ __ __________ Total Length _____________ c C/ D'-Box __ ____- Type Filter Mia-feria _ Dep h Filter Material _______ ----------------- *--....__-_ £ Distance totnearest: Well .:_,7:: fFaundation __,:�_ �________ Property Line -�-�______-____. j x - SE- AfYE-PES [ ] Depth _f __ Diameter _�_ ____jNumber .__.__�r___1_________________ Rock Filled Yes, ( Na �S Water Table Depth ------------------------------------------------Rock Size ----- �-•- Distance tonearest: Well -----------------------------------------Foundation ---.---------------...Prop. Line ---------------------- N REPAIR/ADDITION(Prev. Sanitation Permit# ________ _____ }' .�,. - --- -------- ------------ Date ------------------------------- SepticTank (Specify Requirements) -------- ------------------------------------------------------------------------------------------------------•--------------------- -•---- Disposal Field {Specify Requirements) ------------- -- -- -------------------------------------------------------------- ------- -------------------------------------------------------------------------- = .!f --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- (Draw --------------------------------------------(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 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 6eco bjec fi or a Compensation laws of California." r� w; Signed . --------------------- •--------------------- Owner f Title ` BY9 11 --------------- ----------- -------------------- ---------- - .(If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - -----------------• DATE /-------` BUILDING PERMIT ISSUED ---------/--------------- -- --- ---DATE -- ------------------------------------- -- ----------------- `ADDITIONAL COMMENTS -------------- ---- ---- ------------------------------- - --------- --- - ----------------------------------------------=--------------------------- ------------------------------------- ------------------ - - ---- -- --------------------- --------- ------------------------------- -- ------------- ------ -- - -------- - ------------ - ------------------------------- Final --- - Final Inspection by; --- _._ Date ' SAN -CAQIJIN LOC L HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M f