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FOR OFFICE USE: I � APPLICATION FOR SANITATION PERMIT ��_/CJ 9 ' -°'-`;-- �- Permit No. _ ______._ ----------------------- ------ -- - (Complete in Triplicate) ---------=---------- --------------------------- Date Issued _;L_- jK jO --------------- This Permit Expires 1 Year From Date Issued 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. 549 and existing RulessrRegulatian � CENSUS TR ------ JOB ADDRESS/LOCA ON $,,2� l�lf y1o� Owner's Name - Phone ..-- . ----:- pr 1 �,t Address i�-F CS - --- ------ City ` f r Contractor's Name .License #l3 Phone -'g --- ----- Installation will serve: --Residence partment House�❑ Commercial ❑Trailer Court ❑ j Motel ❑ Other ---- ----------- ----------- -------------- Number of living units: ----.-- Number of bedrooms "-------Garbage Grinder ___' _- Lot Size _ �C ►�-------------------- Water Supply: Public System and name ------------------------------------------------------------ ------------------------------- -----------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peau Sandy loam Clay Loam `❑ Hardpan E] Adobe F-1Fill Material _ a_.-,-.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 seep a pit permitted if public sewer is available within 240 feet,) �1 PACKAGE TREATMENT [ ] SEPTIC TANK'[ Size'X_ __XI -�------------------------- - Liquid Depth _Y -.--------------.----- d ►Capacity -hSd®-- -- Type - -----{-----__ -- Material--- No. Compartments r ...---=---- ....�- _- �... -.— ------�--SFoundation ---- - --- Pro -7------ - Distance to Weare t: Well ----_______----------- �_ ---------- � --_----- p• Line ------------ LEACHING LINE [ No. of Lines ____--�------------- Length of each line ------ Total Length - r;R- 1?-.__--_------ 'D' Box .- Type Filter Material ------ P - ------KI-----Depth Filter Material. ----_-- - --- ----------------. - Distance t-o B_a-rest: I Well --------��i........ Foundation __ �__p__.......... Property -Line. _S-.-of__.--__--_- U. T [� Depth __-1A_------- ig-x_h-- Number ---------:--c Z------.--- Rock Filled Yes No .0 Water Table Depth -------------- stock Size ` ' x �`� ------------9- 3 � i Distance to nearest: Well -------------t n-6_--•------.. ---Foundation --.-_')O-____- -- Prop. Line ---------------------- REPAIR./ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) ` Septic Tank (Specify Requirements) ---------------------------------------- -------------------------------:------------- ----------------------------- r. iDisposal Field (Specify Requirements) ----------------------------------------------------------------------------------------------------Y-------------------------------- ---------------------------------------------------------- ------------------------------------------------------------------------------------------- ------------------------------------------ (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: l "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 be me s )ect to Workman" ompensation laws of California." Signed ---- - --- ---------------�_) - --------- - ----------------------------- Owner ---------1------- Title .. BY --- -------- --- --- ----------------- ---- - (If other than owner) FOR DEP TMENT USE ONLY APPLICATION ACCEPTED BY -- --_-4_,e,, -- __-- __-- ---------------------------------------- ------------------ DATE - "� -`- -------------------- - -------- - BUILDING PERMIT ISSUED -------------------------- - ------------- -------DATE ----------------------------------------- ADDITIONAL COMMENTS -------------------- ------------------------------ --------------------------- ------------------------------------------------- ------- --- -------------------------------------------------------------------------------------------------------------- --- ------ --- ------ ------- ------- ------------------- -- -------- - ----------------------------------- _ ---------- ------ - -------- -- -- Final Inspection b = Date �'� G SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'S$ Rev. 5M.