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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------ ---' = -----------------------------X�_\ (Complete in Triplicate) Permit No: S r7 -____._- _ * t �_ - This Permit Expires 1 Year From Date Issued ---------------- ---------- --- --------- Date Issued Application s�hereby ade,to tl3e San Joaquin Local Health District fora permit- ,J described. This'application*is made in compliance with County Ordinance No. 54 and, existing Rules and Re elation - p t„tonstruct and install the work herein JOB ADDRESSAOCATION s. 9 Owner's Name 1 --CENSUS TRACT ----._- -------------- i_ I_ -- ----- =--------Pho Address - ---- ------ ------- - f - [ ;, 2�� r7---- _ Phone Contractor's Name Cit _ dc..�----------------- �.,--_---— - License # Phone - Installation will serve: "'�_ i ResidencetApartment House❑ Commercial []Trailer Court ❑ —Motel El Other F Number of living units.-___-/-_-- Number,�of bedrooms ----- ------------------------------- Water Grinder [�_Q_--_ � , Lot Size & „� Water Supply: Public System and name ' i --------------- t i Character of soil to a depth of 3`feet: Sand' ------------------------------------- ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay'Loamrivate r ❑ Hardpan M ❑ Materialf yes,tY,pe -- p _ Adobe Fill [Plot plan, showing size of lot, location of systeni rn�relatron to -wells, buildings, etc. must be placed NEW INSTALLATION: ' p on reverse side.) {No septic tank or seepge'p`it permitted if-public sewer is'available within 200 feet,) PACKAGE TREATMENT Capacity JC �, A [ ] SEPTlC TANK'[ ] 1- Size_------� - _ - I . Depth Materidl [ f - No. Compartments d] Distance to nearest: Well ___-___ _ "”` "-'-------f_Foundation ----- - --- _"--- Prop. Line __L_C�_.___•--__--- \� LEACHING LINE---••-[--]--.No:-of-Lines)__.--_,:�- .__- Length of each line-----7� �_ - Total 'Length e U D' Box T .1 ------------- ,u Type Filter Material _/��Cyl� - Depth Filter/Material d , >; ------------------------------- Distance to nearest: Well ��.® , ;oundation _ fO SEEPAGE PIT r 7 F . ---------- F Property Line __ `-�" [ 1 Depth �= =`. Diameter ✓ c_ ) ,X r< Num r"�, d , D ~ ' �� ------- Rock Filled Yes �No i❑ Water Table Depth ) -------------------------------- i ' s ---- ----=- ------Rock Size _-��•'�__.-"�.�� .c 1 1 Distance to nearest; Wel! � REPAIR/ADDITION_[Prev. Sgnita#.ion,Per ___ ___--__- -Foundation ___lam""- --._- Prop. Line ._ "�___ i �.. #-_ - �v �..._. `t`------ Date - ) ts) __-"-. - Septic Tank [Specify Requiremen _ r Disposal Field (Specify Requirements) ___-------- ------- - _____________________r_j_____________ I _ _______________________________ ---(Draw existing and required-additioti on reverse side)` ,.-. _ hereby certify that I have prepared this application and that the work,will be done in accordance with San Joaquin .� CountyOrdinances, State laws, and Rules and Regulations of the. San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "1 certify that in the performance of the work for which this permit is issued, I shall not employ a•n i as to become subject to Workman's Compensation laws of California." p y Y Person in such manner Signed ---- ---- ---- ------ -- -- ---- -------- , Owner BY (If ot = 9-------------------------- -7ite� _er t� fYF,Olt� ' DkpARTMENT USE ONLY APPLICATION ACCEPTED BY t- BUILDING PERMIT ISSUED ----------------- ----- ------------------------------------ DATE ---7_--11 -- .. ADDITIONAL COMMENTS ---- ------- ---- ------ ------- ------ -------------------------/-------- -------------DATE -- --- -•--•- ---•---------- -------- -- - - --I------------------------------- -------- ----- - ------------------------ - -- r --- ----- ------- F { -- - - --- Final lnsp -------- ---- - ------------ ---- ---------------------------- - - -- - --- - -------------------- - ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M