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FOR OFFICE USE: ti +___. --- APPLICATION FOR SANITATION PERMIT --------- --- (Complete in Triplicate) Permit No. ----------------- -------- ------------------------------------- 1 -_-________-------------------------------- This Permit Expires 1 Year From Date Issued 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 Rules and Regulations: TION � 'JOB ADDRESS/LOCA ............... ------------------- - -------CENSUS TRACT --------------- ---------- Owner's Name � -------- ----------------- •-------------------Phone --�b3_-=714 g Address ' Ci -��----------------------- ---- --- :Y ?- }------ ------------- Contractor's Namef �_ �i°.t��.r,�-'C------5----�e-}�-Tl C:G-�a�_�,�:.License # ��9�� __ Phone /y Installation will serve: Residence ['Apartment House,0 Commercial :❑Trailer Court ❑ Motel ❑ Other _ Number of living units:--- -_-__- Number of bedrooms ____ Garbage Grinder '/Y" ----- 9 Fxi�----- Lot Size _lam-Q----�--�-�-------------- � Water Supply: Public System and name -------- 4 __,!�_R-0-------.5- _ _ Q ----------------------- ------Private ❑ ' Character of soil to a depth of 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 available Within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size------------------------------------------------ Liquid Depth ---------.---------------- Capacity -------------------- Type -------------------- Material-------------.--- No. Compartments Distance to nearest: Well -----------------------------------..Foundation ---------------------- Prop. Line ____________....._____ LEACHING LINE No. of Lines �' [►�]� -------- -------------- Length of each line-----�4-------____-- Total Length ----�_�---•----_--- 'D' Box -- a.--- Type Filter Material ______�9__/"___Depth Filter Material _____________ Distance to nearest: Well __ V_0_ -{_a�_1 __ ____ Property Line ____ c�___l �-�___ Foundation ______-_ _ 71 _ _ SEEPAGE PIT [ ) epth __5PPIP- Diameter V,4f1JjPNumber ---------/ ______________ Rock Filled ,Yes No � s Water Table Depth--------•- s/ -------Rock Size ---- -------------------•------ t�f r Distance to nearest: Well ______ _ ff/_V-:_______________Foundation -6-A9---------- Prop. Line ..�._✓___.____....__.. REPAIR/ADDITION(Prey. Sanitation Permit# --.- ----------------------------------- Date ---------------------------------_) Septic Tank (Specify Requirements) ------------------------------------------------------------------------- Disposal Field (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------------------- --------------------------------- ------------------------------ ---------------------- -------------------------------------------------------------------------------- (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, 1 shall not employ any person in such manner as to become subject to Workm 's mpensation laws of California." t Signed _.. - . --- -- -------------- Owner --------------------- - By ------------------------------------------------------------------------------------------------------- Title------- --------------------- ---------------------------------------- (If other than owner) FOR DEPARTMENT USE ONLY r� APPLICATION ACCEPTED BY __. DATE -- -- ---------- -------------------------------------- -------------------------------- BUILDING PERMIT ISSUED --- ---- -------------------------------------- DATE ------____-- ---- - ---------- --- ADDITIONAL COMMENTS ______ -- - --------- ------------------------------ ------ - " --- ----------------------------------•---------------- _ ------------------------------------------------------------- - -- -- -- ---------------------------------------------------------- - - --------- ----------------------- ------------------- - ------------- ---------------------------------------- ------------------ ----------- --------------------------------------------------- Final Inspection by: . - --------------------------Date -------- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M