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FOR OFFICE USE: ' APPLICATION FOR SANITATION PERMIT A ----------------------- ----- ' Permit No: . -/6 '9 (Complete in Triplicate) Permit --- .--.--_ This Permit Expires 1 Year From Date issued Date Issued -_ G-- � _ # fj Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This applicotpn is made in compliance with County Ordinance No. 5 and exi ' g Rul s and Re ulatio JOB ADDRESS/LOC O4 Q f C N S AC ----- Owner's Name ---- li?! -------------------------------- ----- -------------------Phone ---- i Address -------------- - - -- - - -- - ---r"- --------- - -------------------- -- 'City �" ----------------------------------------- ----•- } Contractor's Nam -- --------- - --- - t._l-.t--- _"__.License day Phone-=„ Installation will serve: _R siden 'Apartment House❑ Commercial:[-]Trailer Court ;❑ 1 Motel ❑Other Number of living units:_.____.. Number-of bedroom Garbage Grinder--Wo-_--- Lot Size _ �-%'� Water Supply. Public System and name -------------------------- ----- ---- --- - --- r= F Character of soil to a depth of 3 feet: Sand'[:] Silt fl Clay ❑ Peat E] Sandy Loam Clay Loam;❑ p ❑ Hard an Adobe.0 Fill Material Q_ If yes,type ___-_----------------_-___ (Plot plan, showing size of lot, location of system in relation to wells, buildings—, etc.,_must,�lje, placed on reverse side.) V NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK Size_ _ _ _ ____'%quid Depth _ 1 ____________ _` V Capacity 1 ------ Type�,�� Material��.�_'___ No. Compartments ___Z„r...-:..__ M p +� ��{ Distance to nearest: Well-,_ -570 ____ Foundation _/ ____ Prop. Line ---------,-_6---- LEACHING LINE' No. of Lines -_r____ Length .of each line__ __l�__r_______...__ Total Length _rf_ _ .''_-_--- D' Box ----/____ Type Fil`ter,'Materia ,__ ._ Depth Filter Material C1' - Distance to nearest: Well -- ------_ Foun ation .-�C_�__-_--______ Property Line ______________ SEEPAGE PIT [ ] Depth ------- --- ----- --' Diameter ------_------- Number - ;-------------------- Rock Filled Yes 0 No 0, k Water 7 ble-Depth �tT------ ' -------------------------------Rock Size -------------------------------- Distance ----------- --------•-•------ Distance to nearest,Well =_`______________ __ -------------Foundation -------------------- Prop. Line -------------_-_-- REPAIR/ADDITION(Prev. Sanitation Permit# ---------_------------------------e---------- Date ---------------------------------- Septic _-_-_----._----------------------Se tic Tank (Specify Requirements) --------------------------------------- Disposal Field (Specify Requirements) __-- _-- -------`fir �___-- 4P--_-- -------------- ------------------------------------- ------------------------------------------------ ---------------L------- --------------------7------------------ ---------------------------------------------- ---------- --------------------------------- ---------- - -------------------------------------- ---- -------------------------- - - ------ -- ------- ----- ----- -------------------------- ---:---=----- ' (Draw existin 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 .Rulds and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify t in the performance of the work for which this permit is issued, I shall not employ any person in such manner Sis to b s 'ect to W aCp�iows of California." I ig --------------- ----- By -------------------- Title (If other than owner) - - ----- ---------- ---------------------------- --------------- OR DEPAiRTMENT USE ONLY APPLICATION ACCEPTED BY _._ ___________________�__.;_ �_ -------------- ------------------------------- DATE % .. i BUILDING PERMIT ISSUED ___________ . __ -__ADD _.__DATE _______________________ ------------------- ITIONAL COMMENTS .__._ r'______________ --------- ----------- ------------------------------------------------------------------------------------------------------------- ------------ .. 4110V -------------- ------------------------------------------------------------------------------------------------ ------- ---------------- `-- a ---------- ------------------------------------- ;w -- --- Final Inspection bY. - -- - ----------------- -----------------------------------------------Do SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M.