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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .7 '�" Permit No. C_ ._-2--------- (Complete in Triplicate) ------ ---- =------------- ------ .. —Da.te Issued"'-54-20 -------------------------------------------- -- >. • This Permit Expires 1 Year From Date Issued ry — r -fi 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, 5.49 and existing Rules and Regulations: JOB ADDRESS/LOCATION ---------------------------CENSUS TRACT Owner's Name = ------------------- ,�---- ------�- ----------------=----------------- Phone Address " /' ` _. City "` ) - � Contractor's Name -..----.----- -6-----" ��-C s: License# �i' .�t' Phone t • ,� Installation will serve: Residence ❑•Apartrhent House Commercial'[ Trailer Court ',❑ P/�t 1 Lj r' �j Motel Other E-. # ------------------ ' Number of livingts:--- ----.-- Number of bedrooms __-. _ units: i� , ----Garbage Grinder. .�'- LorSize ------/`-t_�i"---------- ----------------- Water Supply: Public System and name --------------------------------------------------------Private,,qT' Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Locini^❑ Clay Loam;❑ Hardpan ❑ Adobe Fill Material 4/0--- If yes, type _---_-------_______________ [Plot plan, showing size, of lot, location of system in relation-to wells, buildiAgs, etc. must be placed on reverse side.} NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer i-s available within 200 feet,) PACKAGE TREATMENT [ 7 SEPTIC TANK'[ Siz t___-7-1X) '� ... ------ Liquid Depth -----=/-fes..-_-_--- _ Materia ---- :- P No. Compartments - -------- I Capacity �,- � - Type -- ---------- ----- �� -w- p --- €• v Dista rice to nearest: Well __------- "-------- ---------__---_Found_Foundation _-��-----_____ Prop. Line --- ----------- 4 d 'f. Fr LEACHING LINE.,,. _ -' No. of Lines -----.-I--------------- Length of eeeach lifnae.__ __t)'_�1.- -_-._ `___ Total Length ./-�.'".- --......_.-_ 'D' Box . ._ - Type Filter Material r - Depth Filter Material -_--"1 - ---=----=----- --• . -- ---------- -- - Distance nearest: Well _--- -"-�-.�__.-_ Foundation "" --�---.-_--__� PropertyLine �� --- _ Diameter - .�o------- Number --------`-------------------- ---- ------ Rock Filled Ye� No :i❑ SEEPAGE PIT Depth w .- Water Table Depth Diamet -f------------- --- --------Rock Size ---J •-`' ---------- , Distance to nearest: Well ---" ""- -------------__-_.-Foundation _ -p-=--"¢Prop. Line ......... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date _----------_.------------_...._-_-} Septic Tank (Specify Requirements) -------------------- -------------------------------- -----------------------------,-------------------- j- .. Disposal Field (Specify Requirements) ------------- ----------------------=-----------.------------------------ ------------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------------------- -------- (Draw existing and required addition on reverse side} r t 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." i Signed --------------------------- -----------------------/--------------``---------------------------- Owner B ---------- Title Com_ ------------------------ (If ----- --- -----------(If of r th owner) Y O TMENT USE ONLY [ t APPLICATION ACCEPTED BY __.---- DATE - --- ------17' ---------------- BUILDING PERMIT ISSUED ----------- - ---- ------- - - ------- ----- -- --------------------------------------- -----------�DATE ---------------- ----------------------- ADDITI' L .COMMEN _--- ----- - --------- - -x �--------------- ------------------------------------ ------------ - ------------------ _ ' -----------I-------------- ---------- --------------------------------------------------------------- ------------ ------------ ------------------------------- ----------- - - - ---- -- - ------ ----------------------------------------------------------- ------------------ - -- ' ---------------_------- - ---- --- -- Final Inspection by-- --------- - -- -- -- -- 1"� I� ALTH -Date _4/-/=J� SAAI)I'/JOAQUIN LOCAL HEDISTRICT E. H. 0 c 1 :68 Rev. 5M.. ...