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FOR OFFICE USE:.10`~` y � APPLICATION FOR SANITATION PERMIT w--------------------------------------------------------- Permit No. (Complete in Triplicate) � --------------------------------- _---------_----_ This Permit Expires ] Year From Date Issued Date Issued _ � . 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 Cou ty Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION -- �.1--.-�- - - ------------- - - --------- ---P.d---CENSUS TRACT --------------_-_------ Owner's Name ----------------- J ------- ---------------- - Phone " Address ------------------------------ - -- -- ; - ------ --------------------------- . City -- ------------- `�------• Contractor's Name ---------------- --•• _-- -- --- -�'�� /-----------.License #1i0_�1-�----- Phone `T-�'K_©--- T 107 Installation will serve: Residence (] Apartment Hou ❑ Commercial ❑Tr iler Court i❑ Motel F] Other -------;X . - _- Number of living units:-----f-__._ Number of bedrooms ___)__Garbage Grinder ------------ Lot Size -------------------------------------------- Water _________-___________________ __________Water Supply: Public System and name ------- --------------------------------------------------------------- ---------------------- -----------------Private ❑ Character of soil to a depth of 3 feet. Sand'❑ ~Silt[t].. Clay ❑V Peat,❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe-E]. Fill Material ------------ If yes,type __________________ ---------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) CS NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,l NA / / �• Ilk PACKAGE TREATMENT X SEPTIC TAN/K'[ Sze---------- --rX_S----------------- ---- Liquid Depth ----- ------------ Ca ---------- Capacity $W_v/_4 Type - -_J _ -a- Material__ .__ No. Compartments ____;rte............... P Y ---- --- YP P t� Distance to nearest: Well ____________________________________Foundation ------------ Prop. Line __`__....__._._________ LEACHING LINE [ ] No. of Lines -------------------------Length ofµeachyline____.._ I______ Total Length ,___--.--__-___.________-_-_ ' 'D' Box ------------ Type FilterMaterial __'________________Depth Filter Material --------------------------- Distance to nearest: Well ________- _____ Foundation _______________________ Property Line ____-_.._-._-_____._.___ SEEPAGE PIT [ j Depth - -------------------- Diameter ________________ Number ----------------- ---------- Rock Filled Yes EDNo WaterTable. Depth-------------------------------------------------Rock Size -------------------------------- • t . Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ---------------------- REPAIR/ADDITION(Prey.`Scinitdtiori-Perriiit# ------------- ------------------------------ Date ------_------------- _---------_l Septic Tank (Specify�Requirements) -------------- -------- -----•------------------------------- Disposal Field (Specify Requirements) ____ ---�1 --- -- - - - - -------- -- -- - - - - -- --------------------------------------------- ----------- - - . �- --- �_e_ -------c3t)�A4 fLl�'S -------------------- ------------------------------------------------------------------------------------------------------------- ------ -=----------------------------------- (Draw existing and required addition on reverse side) 1 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 become subject to Workman's Compensation laws of California." Signed --- 1� ----------------------- Owner BY -- ----- - --C.O-------------------------- Title `--" - ---�------------- ----- ------------------ ---- �ofe_r�/owner �. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B s cUt'►- 4------------------------------------------------- DATE ��'�-�04. ----------------- BUILDING PERMIT ISSUED �- --- -------------------- ----------DATE -------------•----------- -- ADDITIONALCOMMENTS ------------------------------------------------ --------------------- ------------------------------------------------------------ --------- -ALL -LiSIT�3-----�!rt-�---__1►'�1��__.�lE ----��1Gt�_--S7�ND�_Q_ S__ 5�7-- r3- ---CCI�I7i A� fll�c� Final Inspection by: �� 9 ij Date ti��c n �N JOAgUI�v LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M �� e .