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FOR OFFICE USE: —�- `- -. . _:_._._6 1,E APPUCAT QN FO SANITATION PERMIT - --------- --------- / ----------I- --- ------------ ------ (Complete in Triplicate) Permit No: ._Z/1 4 - ----- This Permit Expires ] Year From Date Issued Date Issued _ 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: I _ JOB ADDRESS/LOCATION D"._K, t AIj�------------- --------------------CENSUS TRACT __S _ Owner's Name - �-..-..•""..___ �. Address ° '� __--------Phone_ � -------------•------------------------------------------------- City Contractor's Name ....... --------- - ------------ ------•----"-.--- ------------------------------------------License # ---- ---- ------------- Phone,will serve: Residence E]Apartment House[] Commercial 'OTrailer Court Number Motel Other ___ ht i of living units:._-___ _____ Number of bedrooms ______-____Garbage Grinder _--______"- Lot Size _ __ _-_ Water Supply. Public System and name _._________"""--"__" �� PP Y - Private - --------- -- --------------------------------- - Character of soil to a depth of 3 feet: Sand'E] Silt.O Clay D Peat❑ Sandy Loam Clay Loam Hardpan (] Adobe X Fill Material P3 - If yes, t i (Plot plan, Fhowpn9,size-of,lot, location,of system in relation to wells buildings, . must be placed on reverse side.) NEW�INSTALLATION- � ' � etc ' {No"eptic�tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK - e . .. ._:�.1_ , __Size-- ------------------------ - - Liquid / a UV Depth --------- -------•- O Capacity 1� Gfti Type MaterialG1.c^re ,� r --"- No. Compartments O ]Distance to nearest: Well __50/ -- -------Foundation __�-p-------------- Prop. Line _ LEACHING LINE -----:---•__ 1 iNa. of Lines _�------------------ Length of each line-----T TV ----- ------ Total Length ---ig�.------ t D' Box ___ "_____- Type Filter Material _ __"�k-"-Depth Filter Material --_!_E��"""__ i --------------•-- V Distance to .nearest; Well __�Q-__-__"-___"- Foundation __.�_""_.- � l�� SEEPAGE PIT Property Line _ - -- ---------- ] Depth -------------------- Diameter ---------------- Number ---------- - Rock Filled Yes p No Water Table Depth ------------- ��f`iv J --Rock Size ------ -------------- 0 ---------------- ----- Distance to nearest: Well ____________------------------------ __Foundation �-, `, -------------------- Prop. Line ----------------•----- REPAIR/ADDITION(Prov:-Sanitafion Permit S# _______________________" _ -------------------- Date ) I Septic Tank (Specify,Re uirementsl _--__ t ----------------------------------------------------------- is osal Field S ecif Re ui�ements ) Y q ------------------- --------------- ----------------------------------------------------------•--------- -_ ---------- ------------------ ---------------------------------------------------------------------------------- --------- ------------- f' ------------------ ------------------ _____ ______ raw 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 shall not employ any person in such manner as to beco e u iect to orkman's'Compenzation laws of California." Signed ------------------------ Owner BY ------------ (If other than owner) " I �". ` - " " ` --- ,Title -- ---------------- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY az ------ - --------------------------- --_- -" _ DATE BUILDING PERMIT ISSUED "-_ o ADDiTIONAL COMMENTS � DAT --------- ---------------------------------------- ------ 3- 1 -- - - - -- ---- ` - --------------- R -- ------------- -- ---------------------------------------------�s�_ ---------------------------------- ------------ - ------ ---- ---- ----- ------------ ------------------------------------------------------------------ Final Inspection by: _____ _ - // ----- -------- ----------------------------------I---------------------------------------Dot --------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M �,