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FOROOFFICE USE: h APPLICATION FOR SANITATION PERMIT V 7 1- ..._ . .... i .. ._3_.•--.......--. � (Complete in Triplicate) Permit No..t ________ _____ This Permit Expires 1 Year From Date issued Date Issued .. .'. -.�. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install rile work herein described. This application is made in compliance with Count-y Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ___ _._ _1�py} _�/� 1 - J--- -- _ ..-•-•-----------------CENSUS TRACT ----_ .................... ` Owner's .Name ._.. .r_.1- '_�_IZ .. .f. l.- ..'e -5----------------•- :----------•----------phone Address - r�'.�.!'.G?..- ` �- City i Contractor's Name1 � - -�-Q..�-r1�-....�"�Y.}. .. License # Phone Installation will serve: Residence[Apartment House 0 Commercial ❑Trailer Court 0 Motel ❑Other _ ...... ------ +Number of living units ... Number of bedrooms ..___Garbage Grinder _110-- Lot Size ________________________..___-___._----__- Water Supply: Public System and name -------------------------•..........................................-•-••.....................................Private C4 Character of soil to a depth of 3 feet:, Sand•❑ Silt❑ Clay ❑ Peat❑ Sandy Loam •❑ Clay Loam Hardpan ❑ Adobe 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT j ] SEPTIC TANK! Size_._._______ �_. _. ------ ..._ �_. � - ._ Liquid Depth ......u.,?-...--••-- Capacity .j:�� Type ___ ____ .. Material_eA1;r&f_'G2e__ No. Compartments -_. .......... Distance to nearest: Well .... ....................Foundation ..,la------------ Prop. Line ...3.©:.......... �f LEACHING LINE No. of Lines --------- 2.......--- Length of each line _--_. ............. Total Length _.1.7Ze.............. 'D' Box ..../....... Type Filter Material .....0........Depth Filter Material _.::../... ..`/.................... Distance to nearest: Well ... 4-l.._....... Foundation _._„ 0..i.......... Property Line ----- ...... SEEPAGE PIT Depth _._1.-.. ;..._..__ Diameter .. }.. .`: Number ._-___.__._3_______________ Rock Filled Yes V' No 0 Water Table Depth -----------�d .......................Rock Size .......-�.� Distance to nearest: Well __...__/.. �________________________Foundation ... _. ---------- Prop. Line ---..1e........... REPAIR/ADDITION(Prev. Sanitation Permit# ........ N0•---__-.________,........ Date ........ ........................) y Septic-flank (Specify Requirements) _....... •-•-•--•--- ------------._ -------•-_- ......... ................. Disposal Field (Specify Requirements) ---------•- -----------------•---•--- - ... ---------------- -----------------•- -------•-• ------ ....................-- ...............................-...-----------------------------------------------------------------..._......... ..... _.. .__.............._._•.... -------------------- - - -- ...._...._...-_...._.................................................... ---•----------. --.._._..-•------ � (Draw existing and required addition on reverse side) I 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 become subject to Workman's Compensation laws of California." 1 Signed -------------------------- --------------------......... - ------ Owner Title .._..._... (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. .. --....... ... .... ........................... DATE ...._..... BUILDING PERMIT ISSUED . - . . ................ .................................--_-------- --------DATE ........................................... ADDITIONAL COMMENTS ._.__._._..._--- •------------------ ......... 5Y- f 7l f -. _...............................•-------- Final Inspection by: __... :.... -•---- ---..Date . , SAN JOAQUIN LOC HEALTH DISTRICT '.E. H. 9 . - T-'68 Rev. 5M (✓