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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------------------------------------- ---------- (Complete -- ----- (Complete in Triplicate) Permit No. ---------------------------------------------------------- Date Issued ---------------------------------------------------------- This Permit Expires 1 Year From Date Issued 3 n Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: J6B ADDRESS/LOCATION .- _ _ /_ _ --- --- ---�'_-- '' ''CEN5U5 TRACT J` ______ Owner's Name 00 INw`�-{- _ !/ ` ''- / ------------- ------------ ----------------- •---•--------------------- Address -------/49,0-V r Yrz�_l� City --------- -------------------------- ------------- s ------------------------ ----;.-• . �` �� Contractor's Name .t l _=--•-_ f --- --------------------•-,--------License , ---- Phone _�-'�' _:- Installation will serve: Residence [$Apartment House❑ Commercial :❑Trailer Court ',❑ k Motel ❑ Other ------------ Number of living units:-----f----- Number of bedrooms _- __.__Garbage Grinder __:__- Lot Size ' ----__-.____-_--___ A. Water Supply: Public System and name ------ ------------------------------------------------------- - ::_ 4 Private Character of soil to a depth.of 3 feet: Sand'R_ Silt❑� Clay ❑ Peat❑ Sandy Loam ❑ Gay Loam:❑ Hardpan Adobe ❑ Fill Material If yes, type _-_______________ (Plot plan, showing size of lot, location of system in elation to wells, buildings, etc. must 6e placed an reverse side.) NEW INSTALLATION: (No septic tank or seepa pit permitted if public sewer is available within 200 feet,} PACKAGE TREATMENT' ['I SEPTIC TANK'[ Size---- -- �------ ---------- Liquid Depth ---T----------.._....-- � i C aclty,44 --P- 4- ----- TYPe Material:�`�_' ° No. Compartments istance to• nearest: Wellr-________________Foundation --1-C9------------ Prop. Line __ _ ___________ _ �_��_ LEACHING LINE [ No. of Lines ___2------_------- Length of each line-- ________ - _______ Total Length �f�___________._.-_ 'D' Box ------------ Type Filter Material 6 4)a/e--Depth Filter Material ` ........... ;E v Distance to nearest: Well ----67)_�....... Foundation --------- Property Line ---16 --------_______ SEEPAGE PIT [ ] Depth ____________________ Diameter __-______--- Number ---------------------------- Rock Filled Yes ❑ No Water Table Depth --------------"---------------------------------Rock Size -------------------------------- Distance to nearest: Well ---------------------------------------Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ___----------------------------------------- Date ---__-.___-_______________________J Septic Tank (Specify Requirements) -,-- -__-_ DisposalField (Specify Requirements] -------------------------- -------- ----------------------------------------------------------------- --------------- W (Draw existing and required addition on reverse side) j I hereby certify that t 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- 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." f Signed --------------------- ---------------- Owner By --- - c� - -- - - E ' --------_ Title ---------------- ----------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---�R_o,---------------------------------------------------------------------------- DATE -----�a=. `. rL._---- , BUILDING PERMIT ISSUED ----------------------------- -------=--------------DATE --------------------------- ADDITIONAL COMMENTS ----------- - ` = - --------------- - ---- --------------- - - - ------------- y ----------------------------- ----------------a-- -------- - -- - Final lnspec ----- ----- -------.Date -------- ----- ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1268 Rev. 5M ��