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i 1 FOR OFFICE USE:+ APPLICATION FOR SANITATION PERMIT ' (Complete in Triplicate) Permit No. �___l �N- ' 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 withCountyOrdinance No. 549 and existing Rules and Regulations: � � i JOB ADDRESS/LOCATIONp,-f. _- �� ----- -------fli 2,,1-6_i+'V__.-- 12---------------------------CENSUS TRACT --.---_-----------...._--- Owner's Name . _---- -_-- �CC� _f - I1 _-Phone Address _177 3�- --- -----•E------- ¢=� f !/-C-------- Cit - f�" ---------------------------------------- yefd Contractor's Name .---- � �..-- - 1fiP--------------------------------License #o�_ .�Q_.__ PhoneZ��.-_4_� - Installation will serve: i Residence Apartment House❑ Commercial :❑Trailer Court ',❑ Motel ❑ Other --- ------------------------------------ -- Number of living units______________ Number of bedrooms ____________Garbage Grinder ------------ Lot Size ___._______-_____ Water Supply: Public System' and name ---------------------------------- ---------------- ------I- ----------------Private [ } Character of soil to a depthLf 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 availa le within 200 feet,) ; PACKAGE TREATMENT [ ] SEPTIC TANK f J Size ______ Liquid Depth -------------------------- .i ---------------- --- Type ---------------- -- Material---------------------- No. Compartments ..•� --- Capacity ------------------•---'� coo Distance to nearest: Well _________________ __________________Foundation _.__ __ _ ___ Prop. Line ----------------------� LEACHING LINE [ ] No. of Lines ________________________ Length f each line----------------------- .___ Total Length ._.____________-_______-____ky D'I Box ____________ _Type Filter Material ____________________Depth Filter ateriaf ----------.__________________________._.__._ Distance to nearest: Well _____---_______ Foundation __ ______ Property Line_ ________________________ SEEPAGE PIT Depth _____ Diameter ______ ________ Number :_._.____._________ ______ Rock Filled Yes ❑ No C s --------------- Water Table Depth `-----------------Rock Size ------ ------------------------- 7 Distance to nearest: Well --------------- -,----Foundation - ----------------- Prop. Line ...... ............... G REPAIR/ADDITION(Prev. Sanitation Permit# _____________________ ___________________� Date ------------- ___________________) SepticTank (Specify Requirements) ------------------------------ ------------------------------------------- ------------------------------,..------------ -------------- Disposal Field (Specify Requirements) ------__ -----------------------------7------- ' = a J / l i -------- ------7��1"�'�X ---- --------------------------- 4 -------------------------------------------------------------------- �` (Draw existing and required addition on reverse side) I hereby certify that I have piL-pared this application and that the work will be done in accordance with San Joaquin County Ordinances, State 11.6 is, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifie's the following: "1 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 ---- --- - -�-------I- -- ------------------------ - Owner t ----= -- ---------------------- ..-------- --- - ------ Title --- ---- --------- ---- ------- ------------ -- ---------------- (If other than' wner) it DEPARTMENT USE ONLY t APPLICATION ACCEPTED BY ----- -- ------------------------------------------- DATE ----'F-^'2--'3 ------------ BUILDING PERMIT ISSUED - ------------ --------DATE -------------------------------- ------------------------------------------ - ADDITIONAL COMMENTS iI ;I ---------------------------------------------------------------------------------------------------------- ------------- - ----------- - --- ------------- - - - - - - - - ------=-- - ---------------------------- -- 4 Date ----------- Final Inspection by - -----------------------------•--- -- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT - E. H. 9 1-'6$ Rev. 5M