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a FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. _._ .Z-=-Z•6 3 ----- ------- (Complete in Triplicate Date issued -_- - - --.�.Z ------ -- -- ---------------- ----- _ This Permit Exp fires 1 Year from Date Issue . - A lication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein decribed. This application is made,in compliance with County Ordinance No. 5.49 and existing Rules and Regulatio/ns: - CENSUS TRACT Y --------- JOB ADDRESS/LOCATION ----------- 1. //�z� ?---�---- = ----- 7 [w Phone ' ' Owner's Name -------------------- ------ --- � l -------- �------ ----C. it - 44&1----------- Address . -----------------•--------••-- License # ------------------------------ - Contractor's Name ----------- Installation will serve: Residence ❑ Apartment House-G'-`ommercialWrailer Court '[1Motel ❑ Other - -- - I---------- l Number of living units:___- Number of bedrooms ------------Gdrbage Grinder _-- --- Lot Size 1 __-_______-__Private ❑ Water Supply: Public System an Warne ------------ Sand Loam ❑ Clay Loam ❑ Character of soil to a depth of 3 feet: Sand' Silt❑ Clay ❑ Peat❑ Y y e ---------------------------- Hardpan ❑ Adobe ❑ -Fill Material __-_-____-- If es,type r ' \ (Plot plan, showing size of lot, location of system in relation ,t wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION:' (No septictank or seep a pit permitted if public sewer is available within 200 feet,) Ul Size__ X�--------- ---------- Liquid Depth ....'1 C ' PACKAGE TREATMENT [ ] SEPTIC TANK , 1 Capacity'i --- --- T -.Material---------------------- No. Compartments ------------- ----•• - s -,��- Type -------------- ` 1 -- I Distance to nearest: Well -JdO----- -- Foundation ��----------- Prop. Line -�-- •---•- --'- , ! ITotal Length --------------- No, of Lines - Length of-each line------3 ----- LEACHING LINE IF - •' - th Filter Material -_--_------J9`_�._____-------•--------•- 'D' Boxy------ Type Filter Material� i - De P I = Foundation ---,fief?-- --------- Property Line -- ---- ' Distance to nearest:-Well- --6V- =Y �/ Rock Filled Yes Lr No 1 Depth ------ Diameter ------- Number = -f Water Table Depth ----------------------------- -`------Rock Size -------------------------------- i Foundation -------------------- Prop. Line ---------------------- Distance to nearest: Well ---------------- i .11 i ------------) REPAIR/ADDITION(Prev. Sanitation Permit -------•---------------- -------------- =--- Date --------•-------•----- ' 'I ----------------- ------------------------------- ----------------------_.--_--------------------------- Septic Tank (Specify Requirements) -------------------------- ----- --------------- ---------------------------- Disposal Field (Specify Requirements) . ----€j- ----- ----------------------------------------- ------- ---------------------------------------- ------ -------------------------------- - ... ..-... _�... _ (Draw existing and required addifiion on reverse side) i I hereby certify that I have prepared this!application and that the work will be done in accordance with San Joaquin i County Ordinances, State Laws,;and Rules and Regulations of the San .loaquin Local Health District. home owner or icen- 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 mariner as to bieco a subject to Wofkman's Compensation laws of California." f Owner Signe Ll � --------------------- i ° Title ----------- ------ ---- -- ------- ------- ------- -------- ------ - - ------------ (if other than owner) t t:� EOR.DJF.PARTMENT USE ONLY _. -- - -----. DATE ------�- ----�----- APPLICATION APPLICATION ACCEPTED B �---- -- - --- - - --- __DATE ------------------------------------------- BUILDING .------------------------- -------------• I BUILDING PERMIT ISSUED ------`-� ----------------------------------------- ADDITIONAL COMMENTS --------------------- ---------------------------------------------------------------------------------------- --- -- � ------------- .Date---------------- ----------------------------------------------------- ------ ------- ----- ------- -- - --- ------ ----�-y--j--� -------- I - - - - ------- ---- Final Inspection b SAN JOAQUIN LOCAL HEALTH DISTRICT 1-'68 Rev. 5M -