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19 `P FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT yy - Permit No. (Complete in Triplicate) z -7 -------------- - -- -------------------------------- --------------------------------------- This Permit Expires 1 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 County Ordinance No. 549 and existing Rules and Regulations- JOB ADDRESS/LOCATION .__!`'Z' ------ r� -------- ---------- --------- ------CENSUS TRACT _-` y7------------ Owner's Name - - --------- �y�. ------ Phone Address --------------- ��_ '_- = � — / ----------- City - - ------- -----------------------•---------------•- Contractor's Name ------479-1v_t,�.?-----------------------------------------------------------------License # ------- ------ Phone ----------------------------•- Installation will serve. Residence..]Apartment House❑ Commercial ❑Trailer Court ',❑ Motel ❑ Other -------------------------------------------- Number of living units:---I------- Number of bedrooms __________Garbage Grinder ------------ Lot Size _15 _--------------------------------- Water Supply: Public System and name -------------------------------------------------------------------------------------------------------------Private] Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam •❑ Clay Loam Hardpan,[] Adobe F-1 Fill Material __________ If yes, type ---------------------------- N, (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on revers 'k' NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) 0 PACKAGE TREATMENT [ ] SEPTIC TANK] Size_ ------------_--------- Liquid Depth ---:l------_-------------- Capacity 141I'"'b-------- Type P-4u-4.+ir----- Material___ -- No. Compartments ------------- Distance to nearest: Well __70_----------------------------Foundation --16-_____________ Prop. Line ___-__.__.-_ LEACHING LINE [k] No. of Lines ._/--------------.----- Length of each line---�0-0---------------- Total Length Lr?�-----------......... 'D' Box --r`t---- Type Filter Material &T---_--------Depth Filter Material _AQ------------------------------------- Distance to nearest: Well ---6-4_r_____________ Foundation ---/A---------------- Property Line �-------.----------- SEEPAGE PIT [ ] Depth ___ - �_____ ___ Diameter . _3__ _______ Number __�_______________-________ Rock Filled Yes-] No 0 Water Table Depth -----70-------------------------------------Rock Size - ---y----------------Distance to nearest: Well _IM_�____________________________Foundation -� --�__.____.__ Prop. Line -`---- ___.-..._.____- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -------------------.--------------) SepticTank (Specify Requirements} ----------------------- --------------------------------------------------------------- ------------------------ --------------------------- Disposal Field (Specify Requirements) --------------------------C---zz—�----------------------------------------------------------------------------------------------- ------------------------ ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------- ----------------------------------------------------------- --------------------------------------------------------------- ---------- --------_- (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, 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 becomeas to pensation laws of Calif nio." Signe a = Owner �r l j�subject to Work ComBY ------------------------------------------e----------------------------------•�- ----- -- ----- Title 0(If other than owner) of FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ ------------------------------------------------------------ DATE --9-�-0 --- BUILDING BUILDING PERMIT ISSUED ------------------------------------------------------------------------------DATE ------------------------------- ----------- ADDITIONAL COMMENTS *"` '��r ��' =P- �� y ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -- - - -------------- -------------------------- -- - - - - - - - - - rZ----------------------------------- - -- + - ,Final Inspection by; _�.4.r-- --- --- -- ---------- ---------------------------- ----------------------Date ---- -- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M