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FOR OFFICE USE: APPLICATIONFOR SANITATION PERMIT q i �� --- Permit Na. - F/7 {Complete in Triplicate} ----------------------- = a Aires 1 Year From Date Issued This Permit Ex Date Issued --------------------------- Application is hereby made to the Sin Joagvin 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: JOB ADDRESS/LOCATION - A� \ .� _, � --------------------CENSUS TRACT ------ ------- ----------- Owner's Name, 6 ) ' - -- ------------- --- Phone - = . Address . Cd ---- ---- ----------- City -------------------------------------------- �r Contractor's Narr�.b - -hA --- -- -t lite-- s---.License #� ��, --- Phone Installation will serve: ResidencegApartment House ❑ Commercial :❑Trailer Court ;❑ " Mote! ❑Other ----- ------------------------------ 40�,�/ 6 Number of living units:__- --_-- Number of be o s� .---Garbage Grinder - --.-- _- Lot (A __--.- + A Water Supply: Public System and name _-_----_---- Jl�!?.Q/tp,�j(�__ - ._ �,� - _ _--_-_-Private ❑ Character of soil to a depth of 3 feet. Sand'❑ Silt{] Clay ❑ Peat 0 Sandy Loam ❑ Clay Loam ❑ # Hardpan ❑ 'Adobe)d'Fill Material (Plot plan, showing size of'. pt,'.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,) PACKAGE TREATMENT o 3SEP�TIC TANK;` '? --- �+ Size d ---- Liquid Depth . ., - " CapacityiRa f} Typef&u�--�-_ Ma er'al No. Compartments __ ------- ._ q ?= Distance,to nearest: Well --- -- - ---Foundation_- ------_----- Pro :Line __-- LEACHWG LINE " No. of�Lines ------------- Length of each line__-_- -�_--.------ Total length #--____,f P Q + -. r I. --- - - D' Box ----- -.►-- Type Filter Materia! Depth Filter Material �� t-------------------------- - = I Distance to nearest: Well --- ----------- Foundation~___4__&_'--.----- Property+ Line SEEPAGE PIT Depth Diameter -- r t /` - ____ Number ---------==--- Rock Filled Yes', No p 3. 2 --�`--- i . 01 Water Table Depth —�of t--�----�-----' [��LL - Rock Size >lt° _,qC r Distance to nearest: Well ------OA-1- f- --_Foundation _.- !.�--.--.-- Prop. Line -----__— REPAIR/ADDITION(Prev. Sanitation Permit# ---------------------------------------------- --------=--------- Date ----------- --------------------Septic Tank (Specify,�Requirements)'-\\---------------------- --------------------------------------------------------- ------------------------- -------------------------;-- r Disposal Field (Specify `Requirements) ---------------- ------------------------ --------------------- ------- ------- --- ! ---------------------------------- ,t - � e I t t ------------------------------------------------------------------------------------ (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- sed agents signature certifies the following: ; "I certify that in the performance of the work for which this permit is issued, I shalt not employ any person in such manner as to beco ect to orkman's Compensati, laws of California." �7 = Signed ` t� �' -- ----- By -------------- -------------------------- AjLA -,------ Title -------- -------------------------------------------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------------- -A-_ DATE -----V�r17-•-4� ---------- BUILDING PERMIT ISSUED ---- DATE ------------------------------------- - -----------------------------------------------------------------------------------------------------I-------------- ADDITIONAL ------------------------------ ----- ADDITIONAL COMMENTS ------------------------------------ _ =_ _ �_:_ ___ -- - ------------------------------------------------------------------ --------------- Final Inspection by. Date J `��-- --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M -•_ — - —