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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �7/ Permit No. --- ----------- ---------------------------------------------------- ---------- -------- -------- -------------- (Complete in Triplicate) ---------------- --- Date Issued ---------------- P ---------------- ----------------------------------------- This Permit Expires 1 Year From bate issue e work rein Application is hereby made to the San ain Joaquin coe wical th CouniBalth ntyt0 dinance rict for a No. 549 and ex sti g Rules ermit to construct and tand hRegula#o s.. described. This application s rn JOB ADDRESS/LOCATION --�7'��'-_ -�- --r��I�C-I'�__C��'------- -��T �_CENSUS TRACT -----------`I---------•.--- /�'� -Phone " 1 LL ----------------- ------------- -- Owner's Name �_-{Ir--- Se-1ZfZr /_�1_G- ! f --- It d- --- ------------------ Address -1----- � Y License Contractors Name ------ Installation will serve: Residence Apartment House'[] Commercial :❑Trailer Court �] Motel ❑Other ------------------------------------------ Number of living units;----- ------ Number of bedrooms --A-----Garbage Grinder _-- __-__- Lot Size Private Public System and name - --------- ---- - ---- ------------- -------- ------- -------------- ----------------- Private Water Supply: y . Clay Loam � y Peat Sandy LoamE] ❑ Character of soil to a depth of 3 feet: Sand' Silt Cla ❑ ❑ Hardp an ❑ - Adobe-E] .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,) N PACKAGE TREATMENT { ] SEPTIC TANK.'[ ] Size------------------------------------------------ Liquid -------------------------- -------- --- - Liquid Depth -----------------•-------- � -_ Material------------------ --- No. Compartments __----------.-.------ Capacit - Type ---------------- qN Distance to nearest: Well -------------- ------- --------------Foundation ------- ------- -- Prop. Line -------------A-------- 11) LEACHING LINE { ] Na of Lines ------------------------ Length of each line--------------------- ------ Total Length .----------- ---------------- ,D, Box.-- ----- - - Type Filter Material -- Type Filter Materia ---------------------- Distance to nearest: We ------------------------ Foundation ------------------------ Property Line Diameter Number -------- ------------------- Rock Filled Yes ❑ No �❑ SEEPAGE PIT [ ] Depth __-- Table Depth ------------------------------------------------Rock Sze --------------------------------- Water Prop. Line Distance to nearest: Well --------------------------------- .-Foundation --------- --------- F ' ----------------------------------- Date ----------- ----•--- ------------ - REPAIR/ADDITION(Prev. Sanitation Permit -------- --------- ------------ '� two_D . Septic Tank (Specify Requirements) -----------------------------------------�----------------------- it------ - --------------------- ----- , .- --�-�°�-- Disposal Field (Specify Requirements) __----- PD----------- , ._ _ -=-----//V------ - E --------------------- �.. EP-TE -- (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- l 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 bec a ub'ect to Workman's C,o¢pensation laws of California." •'} y� /�\.. Owner Signed t 1 `�6' �\ --------- ,. (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- --------- --------- --------- - DATE --- 1 BUILDING PERMIT ISSUED -- ------- -------- ---- --- -------- ----------- --------- ------- - - ---------------- - -----DATE -_----------------------------------------- ADDITIONALCOMMENTS ------ - - ----- -------------------------- ------ --------- ------- -------- -------- -=------------- --- Z---------- ----------------------------------- --- --------- -- ----- - -- ----- _'-_.------- ---------------------------- Final-lnspection b : __ ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M