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FOR R OFFICE USE: "—APPLICATION FOR SANITATION PERMIT D �/ A �' `� Permit No. ---------- (Complete in Triplicate) --------------------------------------------------------- This Permif Expires T YearFFo-eDdte Issued"'"�"-`�•`�"__,1Date Issued 1-______ _______ Application is hereby made to the:San Joaquin Locaf'1 le8lfih xDi4ActNfor a permit to-construct and I install the work herein described. This application is made in compliance with County Ordinance No. 549 and Iexisting Rules and Regulations: JOB ADDRESS/LOCATION --------------- - t CENSUS( TRACT . i - i �1_ _ S > Y7--- "-owner's Name --------------`- - - -- -----------�-I-C - - - - -- - - - - --- -- - . " yy P ode • - Address = ----- .-- - - ---- - Contractor's Name .__ `- - - - tel- Oy ense # � - ��,--- hone - y- �'�-1---- t ! r Installation will serve: Resi ante['Apartment Houses Commercial'❑Trailei Court P Motel ❑Other ---------------- F' d ----- Num'ber of living units:_"___ .±_-__ Number of bedrooms _ __Gar agei der ___ _______ Lot Size Water Supply: Public System and name ------------------------ ----- %0- ---------•--------------i----------• Private ❑ t El Character of soil to a depth of 3 feet`: _ Sgrrd'SAdobelaFillateeal _-__ l Sandy eS,�me❑ Clay Loom .❑ ❑— ❑_ Y _❑ .- - 3 Hardpan ❑ ` Y tYp I buildings etc. must be placed on reverse side.) (Plot plan, showing size of lot, location of system in refafiio. to #we11s, � NEW INSTALLAtION: (No septic tank or seepage pit permitted if kpublic sewer is available within 200 feet,) t �.�' k PACKAGE TREATMENT { ] SEPTIC TANK'[ I Size----------------- --------- 1 --- Liquid Depth ---------------•---,----- V Capacity ------'------------= Type --r------ _-_ "=M xter�E Iaoundation --- No. Compartments ----------------- ---- Distance to nearest: Well ____---- F I---------------- Prop. Line __________...:_;______ LEACHING LINE [ ] No. of Lines :":_-_�--- ______.__ Length of each line--------- ------- __ Total Length ��__�__________ r ------- r 'D' Box _____I_ __°Type Filter Material ___Pe, Depth )Filter Material t yY � ___ __" . ___________-_-_---______ nProperty Linebistance to nearesti We ---- Foundato 4&PA E PIT Depth Number ___.______lRockFilled No ❑ - ra ter r t25 - .___ —2Water Table pepth ------ f Rock Size -------- :_ ------------------- Distance to nearest:`Well,___-___ _1 ------------------------Foundation ----- --------- Prop. Line __- __-__________-- REPAIR/ADDITION(Prev. Sanitation Permit# -------- ------!-y_- ..__----------------Date—__-----------_- -----•-----) SepticTank {Specify Requirements) ------- -----------------------------------------------------------------------------------------------------------•---- Disposal Field (Specify Requirements) ------------------- --- ------------------------------------; ---- --- ------------------------------------------------------- ----------------- (Crow 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 Mules 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. J Signed ----------------------------- --- -------- - ------------- ---- - ---- lener n ------------------ B { fir' ----------- ----- -------- Y ------------- - (If other owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B ------------------------------------, DATE __.- ------------- BUILDINGPERMIT ISSUED -------------------------------------------------------------------------------------- --------------DATE --------------------•------------------- ADDITIONALCOMMENTS ------------------------------------------------------------------------------ ----------------------------------------- --------------------------- --------- --------------------------------- ----- --------------------------------------------------- r -- 7 Final Inspect -ion. --------------.Date _...-- "- ---- - 7 SAN JOAQUIN LOCAL HEALTH DISTRICT E. H, 9 1-'613 Rev. 5M