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FOR OFFICE USE: y r PPLICATION FOR SANITATION PERMIT Permit No. -------------------------------- " (Complete in Triplicate) ------------- -----___ _ _ Date issued�_:'_,�=�� This Permit Expires 1 Year From Date Issued _ • q County Ordinance No. 549 and existing Rules and Regulations. Application is hereby made to the San Joaquin Local Health District fora ermit to construct and install the worrein described. This application is made m compliance with C Y .�� 2-63Brthm __ _ -,-_ h . TRACT `-------------- {,---•---- JOB ADDRESS/LOCATION --- 93 -- Owner's Namea 1i>'!a--------------------- ---------- ------------------------------------ -------Phone ------------------------------------ Address --------- ------ - ----------- ------------ -----=----- ---------- ---------- ----------- -•--- City ---------------------------------------------------------------------•------ Contractor's Name License # 1&1'7- h------- Phone -------- Installation will serve: Residence ®Apartment House❑ Corn Mercial ❑Trailer Court iEl Motel ❑ Other ------------------ - Number of living units:----1----- Number of bedrooms _2_-_...__Garbage Grinder . "° -- Lot Size _. 00.r �:�_ QO t - •------ Water Supply: Public System and name ----------------------------------- - k-'--------------------------""""-- _______________Private X] Character of soil to a depth of 3 feet: Sand'❑ Silt ❑ Clay ❑ Peat ❑ Sandy Loarn {3. Clay Loam :❑ V ` Hardpan ❑ Adobe; [ 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 pit permitted if public sewer is available within 200 feet,] tt ti ti t d PACKAGE TREATMENT [ ] SEPTIC TANK ft Size_ t1 ''------""--x56._^ -----T- Liquid .Depth !- --- -- }---- Capacity 1200 TYPe �'' "fit__ Material_Q_an�T'et_0 No. Compartments _2--------- PY -- - ------- Distance to nearest: Well ___:__ ......................... ------- (]-t--------- Prop. Line .-----2Q_.___.-•--- , LEACHING LINE [ ] No. of Lines __2_.__._______------ `Length of each line---------80!____.______ Total Length --16-012 r 1x3 4 18'-j'--------- ] 'D' Box __.;L------ Type Filter Material ___a-____1..----Depth Filter Material ___ ' Distance to nearest: Well ----- 1_4b Foundation -------------- Property Line ___10!.---- ----•• -___�� Rock Filled Yes ❑ No i❑ SEEPAGE PIT Depth Diameter Number ------------- i s Water Table Depth -- --------------------------------- Rock Siie = = Distance to nearest: Well ................... --------------------Foundation _.------------------ Prop. Line _.-----_"----_------- I -----------------=-- Date ----': ----- -------------_------- REPAIR/ADDITION(Prev.{PreySanitation Permit# ....---- --�-- ------ " f a Septic Tank (Specify Requirements) -------------------- --..---------:------------- Disposal Field (Specify Requirements) ------------ ---------------------------------------------------- ----------------------------------------------------------------------- ----- ------------------------ ------------------------------------------ -------------------------------------------- -------------------------------------------------------------------------- (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 i Count`) Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Homeowner 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." Signed -__.. .: Owner --------- 0 = � - - ----------------------- rtitle Er _1 �n1 ------- --------- r By i er,tha. ,o - .. r _ d -�_--{- r__ FOR DEPARTMENT USE ONLY . APPLICATION ACCEPTED BY - __-- - - - --- ------------------------ ----- DATE _'``6_�----- ---------------- r BUILDING PERMIT ISSUED ------------------------- ------------ --------------- --------------DATE --------------------------------------- - ADDITIONAL COMMENTS --------------------- ---------------------------------------------- -----------------------------------------------------------=--------------------------- ---------------------------------------- -------- ------------------------------------------ ---------- ---------=----------------- ------------------------------------- __. _ _ - _ _ _ ------------------------------ . � ' Final Inspection b --- -.Date ----- --- - -- ---- --- SAN JOAQUIN LOCAL HEALTH DISTRICT .° m )E. H. 9 1-'h$ Rev. 5M ,