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FOR OFFICE USE: � ' � U' �� _/�OFFICE - ,PPLICATION✓FOR SANITATION P1E[ T a (Completein Triplicate) Permit No.. __ 'iQ�� F --------- ------------------------------------- - Date Issued --------------------------------------------------------- This Permit Expires 4 Year From 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: F JOB ADDRESS/LOCATION .WW-RA_D/o9------- '---------------------------------------------------CENSUS TRACT -------------------------- Owner's Name ---------15_1B-------- /9 S r----------------------------------------- -------------- -------Phone Address_�_1- -----------rR�I}-s-LIRE 'If----------------------------- City �T-p-C --------------------------------------------------- r �¢�-------------' - Contractor's Name -4& ----... [ -------.License # L77.f1SS3-- Phone Installation will serve: Residence ❑ Apartment House-RL-'Commercial❑Trailer Court i❑ Motel ❑Other -------------------------------------------- Dumber of ,living units_____________ Number of bedrooms ____________Garbage Grinder --------- Lot Size ---------_------------------------------------ Water --------------____-__- __________Water Supply: Public System and name ----------------------------------------------------------------------- -----------------------•---------•-----Private [ .. r" Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe:(�FI! Material ------------ If.yes,type ------------------ ------- {Plot plan, showing size of lot, location of-,system.in.rel6tion-to wells, buildings,-etc. must be placed on reverse side.) O NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT .{ ] SEPTIC,TANK [ ] Size.----------------------------------.------ - -- Liquid Depth --------------------------- Capacity -------------------- -------------=------."""--Ca acit Type __________ _ : Material__ __ __ No. Compartments " ' l Distance to nearest: Wel! -------------------------------------Foundation"'--='_'------------- Prop. Line ---------'"_----____-- LEACHING LINE [ ] No. of Lines ------------------------ Length of each line---------------------------- Total Length ---------------------------- r f 'D' Box ------I------ Type Filter Material --=-----------------Depth Filter Material -------------------------------------------- Distance tol nearest: Well ______________________r_ Foundation ---------------------- - Property Line --------------- SEEPAGE PIT [ ] Depth ______ _____________ Diameter ---------------- Number -------- ------------------- Rock Filled Yes ❑ No Water Table Depth ------------------------------------------------Rock Size ----------------------------- - Distance to nearest: Well ----------------------------------------Foundation ---------------.---- Prop. Line ---------!f------------ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ------------------.--------------- Septic ---------_---_Se tic Tank (Specify Requirements) • Disposal. Field (Specify Requirements) _-ye_d_----- t1 ----'--- �_-`---c - - `- ��---- fr _- --------------------------------- --- ---- - - ---------------------------------------------------------------------------------------------------------------------------------------------- # {'Draw existing and required;pddition on reverse side) I hereby certify that I have prepared this application andthat the work will be done in accordance with San Joaquin i 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: t . "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 becom subject to orkm 's Compensation laws of California." Signed -. -___- -19�_ __ #. ___ Owner T ----' ---,----------------------" --------4----- BY ----- -f----------------=------------------------------- Title --------------- ------------------------- ------ (If other than owner) ' li OR DEPARTMENT USE ONLY # APPLICATION ACCEPTED BY --------- ---- _---------------W - -- = ------------------------------ ---------- ------ ---------- DATE ---��_�_____'�._ • --_ --- - --•--- � BUILDING PERMIT ISSUED - ----------- ° - '� x --------1------------- ---------------------------=--------------DATE ------------------------------------------- ADDITIONAL COMMENTS --------`---- '1------------------------ ---i-------------------------------= - ------------------------------ - ----------- -- - v --`- ----- ------ ---------------------------------------------- - - ---------------- ------ �. ---�H------ ------- - ------------------- ------------------------------------------------------- ----_ _---------- r --- Final Inspection b -----•---- -------- --- ---e'er-------Date - - , l SAN JOAQUIN LOCAL HEALTH DISTRICT t E. H. 9 1-'b8 Rev. 5M. c