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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT- l ��t � � Permit Na --------- ------ - (Complete in Triplicate) --------------------------------------- This Permit Expires 1 Year From Date Issued ' Date issued -.la--5---Lry� Application is hereby made,to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules nd Regulations. JOB ADDRESS/LOCA ION .---------- ��,1------ =- C�--��}-------------- ---CEN5U5 TRACT -------------------------- i / ` Owner's Name �-"" � ► f __�- �1, -Z-4,hor� - ` Address --------- ` ` '` e�' ,3 0 City - ---- --- -- - i 1,CcP -----------------Phone -------------- --------•---•-- Contractor's Nam _ -- --- - = - - - v / �----.License # --------------- Installation will serve: Residence F] Apo House ❑ Commerc'iat541—railer Court ❑ ,�Af �{ T,, Motel 0 Other --------��---__----p---�--��--------------------- a ° Number of living units------------- Number of bedrooms '� `�_�Ga"r�S05 sin er��'._____ Lot Size -f r -_---------_-__---- Water Supply: Public System and name ----------------------------------------------------- -------- ------------------------------------------------Private I Character of soil to a depth of 3 feet: Sand'E] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ s iHardpan'❑ Adobe Fill Material ------------ If yes, type ----------------------------- (Plot ____ ----(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 200 feet,) PACKAGE TREATMENT.. [ ] SEPTIC TANK Size-- -`_ $-'-? __ _�.'--- -- LiquidDepth ---- "�-�r-- ---- 4 Capacity -- _ Type s __---�- __ Material � � __ No. Compartments _--_ Distance to nearest: Well��--------------_-._--------.Foundation ---- t.--_-.--_ Prop. Line _1_�___---_-.-_ LEACHING LINE No. of Lines -1- --------------- Length of each line--_� `_____.______ Tota! Length -------�_ _ _ Type Depth Filter Material 1__ 'D' Box .--.- T e Filter Material - - �-------------- ---------•------•---- {Distance to nearest: Well Aft_'*-_-------�ation �-]-_0---'_---.---- Property Line �_- ! / __ -_ - - -------- SEEPAGE PIT_' !Depth-1--S-----.----- Diameter 3_3_1___ Number -_,P- ------------------ Rock Filled YesV No 0 � f Rock Sizes=r tj Water Table Depth ------------------------- l —, Distance to nearest: Well ----�__c> - ----------------------Foundation ___--_o0 X-- Prop. Line -------.�_._.-__. REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) 1 SepticTank (Specify Requirements) ---------------------------------------------------------------------------------- ----------:---------------------------------------------- Disposal Field (Specify Requirements) -------------------------------•---------------------------------------------------------------------------------------------------- A I x +;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, avid Mules 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 beco s. ct to_7 V ork n's Compensati.on laws of California." Si ne -- --------------- fir— F By ----- ----------------------------------------------------- - �.--- ------- - ---------- Title ------------------------------- --- ------ ------------- ---- (If other than owner) TMENT USE ONLY APPLICATION ACCEPTED BY ---_---- = - �- - -- ----- --------------------------------------------- DATE S ,` �. ---------------- BUILDING PERMIT .ISSUED ------------ - --- ---- ---- ---- I - --------------- DATE ADDITIONALCOMMENTS ---------- - - --------------------------------- ----------------------------------------------------------------- -- ------------------ ---- ------ fi- - ----------------- ------ ------------------------------------------------------------------------------------ -----------------=------- Final Inspection b --------- ---------------------------•------- --------------------------------Date �4= -------- ---------- N JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M.