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FOR OFFICE USE; ' APPLICATION FOR SANITATION PERMIT ----------------- ----------------------------------- --- Permit (Complete in Triplicate) ------I--------- ---------------------------------I This Permit Expires I Year From Date Issued Date lssued !Y�7/-. -----------------------------------------:---------- Application is hereby madeto the Son Joaquin Local Health District for a per'mit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations.. Z JOB ADDRESS/LOC CENSUS TRACT -------------- ----------- Ti -----tr 4------- Av�xo-�------------ 4f ----------------- Owner's Name 2%3/�------ -------- ------ --------------------------------------Phone - Address ---- ------- city ��i /#?G '--------------------------------------------------- � Contractor's ------- -- --------------- Contractor's Name --- - --- V- - e------------------------------------License Phone�FP3-7:4A--A-� ---- - Installation will serve: Residence [R Apartment House,E] Commercial :E]Trailer Court ;E] Motel ❑ Other -------------------------------------------- -- -- Number of living units:_.--.--_.-_ Number of bedrooms -________...Garbage Grinder ------------ Lot Size 3?0 /Z?4 ---- -------- ------------ ---- Water Supply: Public S stem and name ------ ty-------A__-- ---=----------- ___Private VL Character of soil to a depth of 3 feet: Sand'JA Silt❑ Clay E] Peat E] Sandy Loam E] Clay Loam-E] Hardpan E] 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 rpit permitted if public sewer is available within 200 feet,) SEPTIC TANK;[ Size---------44K - -------- Liquid Depth S. PACKAGE TREATMENT --- ---------------------- C� cterial-d��-No. Compartments ---------------- Distance 1>16V------- hype D a rice 'to nearest:- Well �-------------<V---------------Foundation ____f-10-�------- Prop. Line -�---------------- of Lines ____.cam____________.--- -------- Total Length --------- LEACHING LINE Noi -------------- Length of each line-------------------- D Box ------------ Type Filter Material P 2��*�-Depth Filter Material ....... ----------- of -7 Distance to nearest: Well ---4' ----------- Foundation -------E--o---------- Property Line ---------------- SEEPAGE PIT Depth -------------------- Diameter ---------------- Number ------------ --------------- Rock Filled Yes C] No 0 Water Table Depth --------------------------------------------------Rock Size -------------------------------- Ilk Distance to nearest: Well --_-__-_______________________________Foundation ----------- -------- Prop. Line ------- REPAIR/ADDITION lPrev.'Sanitation Permit S# -------------------------------------------- Date ---------------------------------- I SepticTank (Specify Requirements) ----------------------------------------------------------------------------------------------------------------------------------------------- Disposal Field (Specify_.Requirements) ---------------------------------------------------------------------------------------------- ----------------------•--------------- --------------------------------------------------------- --------------- --------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------- ------------------------------------------------------------------------------------------ -------------------------------------------------------------------- (Draw existing and required addition on reverse side) I hereby certify that I hav! 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-a 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 become subject to Workman's Compensation laws of California." Signed ... 42----W-------------------------- Owner By ------ --------- I T ------ --------------------------------------------- ---- -------- ------------------ ----------------- itle (if other t�han;owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------- -1 -—---------------------------- -------------------------- DATE --- ---------------- BUILDING PERMIT ISSUED:il--------------------------------------------------------------------------------------------------------DATE ---------------------------- -------------- ADDITIONAL COMMENTS -1M I --- ---- -------------------- ---------------------------------------- ---------------------------------------------- ---------------------------------------------------------------------- --------------------------------------------�11----------- ----------------------------------------------- --------------------------------------------- ------------------- ---------- ------------------- ----------------------- Z ---------------------------- --------------- Final Inspection by: ------------------/,�; -------------------------------Date ---- ---------- ------------------ ------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M