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M FOR OFFICE USE: 7f APPLICATION FOR 'SANITATION PERMIT �� (Complete in Triplicate) Permit No: ____________________________________ This Permit Expires 1 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: JOB ADDRESS/LOCATION .-Sdtjl'll, 577 --CENSUS TRACT i Owner's Name ------;91-9,44-05------------------------------------------------------------------------ -------Prone Address '--------,9"_:7�----------------------------------- City -=---5-,7-L2ACTz21-y------------------------------------- Contractor's Name ---Ills -1� ----------License'# I-7 - - Phone IInstallation will serve: Residence P(Apartment House°❑ Commercial ❑Trailer Court ;❑ M Motel ❑Other ------------------------------------------- - Number of living units:----1------ Number of bedrooms ---oZ-----Garbage Grinder IVO.. Lot Size ----�-%_filer ___--_------- Water Supply: Public System and name ---- ---------------- ----------------------------------------------------------------Privatei' Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay .❑ Peat❑ Sandy Loam ❑ Clay Loam.E_] IHardpan' Adobe'❑ Fill Material --- ---___ If yes, type ------------------------_--- � I ) (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,) { PACKAGE TREATMENT SEPTIC TANK Size---- �r-_ --_X_"_ _ qDepth Capacity a-f?O Type�t�°��l` Material No. Compartments A__--------- ---- Distance to nearest: Well -------------- ------Foundation --167-.r----------- Prop. Line --------- ---------- LEACHING -------:__._---_ ------- Length of each line----- t � +' LI"ACHlNG LINE [ No. of Lines g _ Total Length �_� --------------- V ' D' Box l�-j__ Type Filter Material A'ga----___De.pth Filter Material _11"O'---------------------- ----- r 0 . Distance to nearest: Well --.---5.'---------- --- Foundation --- ------------ Property Line. -- ___ .-_._-_-- SEEPAGE PIT Depth -- - -------- Diameter 113--------- Number -------�---------------- Rock Filled Yes ;� No ID Water Table Depth `700--- --------- ---------- -------Rock Size _-1 Z_4 j--------------- Distance tb nearest: Well -------------------------Foundation Z_0-1-------- Prop. Line .... --___-____-. ` I REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date ----------------------------------) SepticTank (Specify Requirements) -- --------------------------------------------------------------------------------- --------------------------11--------------------------- I Disposal Field (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------------------ I -------- --------------------------------------------- -------------------------------- --------------------I-----------------------------------------------------_.- -------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) I hereby certify that I have prep Ired 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 iVtheperfo mance of the workfor which this permit is issued, I shall not employ any person in such manner as to become sorkm s Co nsa ' n laws of California." Signed ----- ------ ------ ----- - -- ----- ------- --------------------------------- Owner BY ------------- ---- ---------------- ----------- Title --- ---- --------- - ----------- - ---------------------------------------------------- ( owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -1--------- - 4�C.t DATE -1 r BUILDING PERMIT ISSUED ------.----_ / --DATE ---------------------------- ----------------------------------------------------------------------- --------------- ADDITIONALCOMMENTS -------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------- - ---------------------------------- --------- -- ---------- ---------------------------------------------------------------------- --- -------- - - - - - - - ---- - --------- ----------------- ---- ---- -- ---- ----- -- - ---- - - r7 , Final Inspection by: ----- -- --------------=----------------- - - - - ---------------------------------------------Date - h'" ---- -- - -�------] - ± SAN JOAO IN LOCAL HEALTH DISTRICT C(�(J/ i �/ E. H. 9 1-'b$ Rev. 5M.