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FOR OFFICE USE: APPLICATIQN"FOR SANITATION PERMIT 7a_//�� �, ,�' � Permit No,. --------------------- ----------------- ------------------'. _�.,'_3�------- {Complete in Triplicate) R 1Z- ------ --------- Date Issued This Permit Expires 1 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: i�er � _-- -------CENSUS TRACT JOB ADDRESS/LOCATION ,_ [a-i-- Phone _ Owner's Name y " Cit - ----- - -�-- ---------•---•----------------••---•---- Address --------------------- --- �� " ----I _- - -------- Y -- Phone V66 Contractor's Name ---- ................ ------ -- -- - - ---. ___�Pwl_-------=---- -- License �# ��------- ---- ------ -•- Installation will.server - - Residence (Apartment House'❑ Commercial:❑Trailer Court ❑ Motel ❑,Other --------------------------------------------- „ ,g ` '~ �- Garba Number of living units:-_"-�__ -_ Number of bedrooms "_-” ___.__ ge Grinder;_____"___. Lot Size ___��-"}X-" --��-�------------------ "- --Private ❑ - - ---- ------------------ ---•----------------•--- ---------------- Wafter Supply: Public System and name --------------------------------------------------------------- "--__-----------" " ----- ---- -- Clay Loam Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ = Peat❑ Sandy Loam ❑ Y Hardpan.❑ Adobe` Fill Material ------------ If yes,type ----------------- Plot Ian, showing size of lot, location oft system. in relation -to-wells;=buildings, etc. must be placed on reverse side.) p F NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) SEPTIC TANK'[ ] Size--------------------------- ------------- ---- Liquid Depth --------------------------- PACKAGE TREATMENT [ ` Ca acit ----= Type ------vMaterial: '--------- = No. Compartments p 4 Y ; Distance.to nearest: Well, ------------------ Foundation ---------------- Prop. Line --------------- LEACHING LINE I ] No. of Lines _'_,-------(-------- Length of each line----------------------------- Total Length ---------------------------- .11� � - -'r 'D' Box __t___-_- -- Type Filter Mafieridl'^___-:-- --------- Filter Material --------------------•-------------------.--• t PropertyLine ----------------- ------ ,, Distance to nearest: Well ------------------"----- Foundation __.___ ---------- ----- Diameter ________-- Number ----- Rock Filled Yes ❑ No f❑ SEEPAGE PIT.� (__]_ I Depth ---------- --------- ---- Water Table Depth ------------------------------------ --- Rock Size --------- ----------------------- tFoundation _ F-------•---- Prop. Line -------------•--•--•-- Distance to nearest: Well--------------------------- 1 Date ---------------------------------- Prev. E REPAIR/ADDITION(Prey. Sanitation Permit# _--___. Le z o G- - ' Septic Tank (Specify Requirements) ------------------ -- ------------------- t -- Disposal 'Field '(Specify Requirements] ---------------• fry - �CrL u16 c : -- - (Draw existing re and uired`' tion on rev11 se side) q ! hereby certify that I have prepared this application and that the work will be done in accordance with San. Joaquin l 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: person in such manner "I certify that in the performance of the work for which this permit is issued,:! shall not employ any F as to become subject to Workman's Compensation laws of California." : Owner Signed ----------------- ----------------------------------------------- I =----_- ------------------------------------I ------------------------ ---------- ------------------------ -Title B __ ----------------- (If other than owner) # F R DEPA1tTMENT USE ONLY ff DATE ------ APPLICATION ACCEPTED BY -- - ------- - --- -------------------------- -- --------- ---- ----- BUILDING PERMIT ISSUED --- ---- -------- - -----------------------------=------------------- ADDITIONAL COMMENTS ---------1---------------------- -------------------------- ------------------- . i_ _ - --------- ------------ __ ------------- -; --- ------- ------ ------__T� _V ---------------------- - ------- ------ ------------------ ------- ------- -- f `----. -- ---- ----- -- 1 r�° tis Date Final Inspection by: SAN ,lOAQUIN 'LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M