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FOR OFFICE USE: g0APPLICATION FOR SANITATION PERMIT _ ------------------1 9-: Q-------------- (,f{' II` (Complete in Triplicate) Permit No: ----------_-----------T 1--------++77r. _L-0_ --___________ ---- This Permit Expires 1 Year From Date Issued Date Issued _ ---____`fes_ 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 an egu a io . JOB ADDRESS/LOCAT /_ 9_ - - --- ,----- TRACT _ �A ' Owner's Name : - ------ - Phone Address ---------1 -7--------- -- - -------- - t City -----------------------------------------•-------•------ r Contractor's Name ------e t ---- ?:_License # Phone -------------------- •-•-•--- Installation-will'server-�--Residence [ 4artment•House-❑-Gommercial-:❑Trailer Court C]i Motel ❑Other -----------------------------------•-------- Number of living units:-----I------ Number of bedrooms�� I_Garbage Grinder _ ------__ Lot Size __I�-S____X__�_s __-______________ Private Water Supply: Public System and name ------------------------ ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ .Clay'❑ Peat❑ Sandy Loam Clay Loam ;❑ r --- 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 pi ermitted if public sewer is available within 200 feet,) \ ' TREATMENT [ ] SEPTIC TANK�[� � o� Size- --�--1�__rY_..S _----�-----____-- Liquid Depth J4...................... a , ;__ No. Com artments PACKAGE Capacity-JPQc @•,Type _ Materia!__- r p # " Distance to nearest: Well -----------/��---------------Foundation _--1 -------__-_-- Prop. Line .��- s i LEACHING LINE [ No, of Lines ------,-�------------ Length of each line a_ So_.-__w4 TotaI Length a9a2______---_-_--__ "; 'D' Box .-_ Type Filter Material -------s,-R'----Depth Filter- Material ------1-Q-.o__._•....................:.... 41 � t V----- 11 � � J* i - l7istance to a est: Well _____�_f?Q_�___--_. Foundation ______�_�6____-_______ Property Line- ---S_________________ T ] Depth ____l#_ -'---------- Diemeter�_el' �_Q_____ Number --------- ------ Rock Filled Yes No i[J ' tWater Table Depth ---------------- ! ----------•--------Rock Size --- OfWell ______________/B 9P__ ___--••___,__-_Foundation ol_1__y___ _ _f__ ___.Distance to nearest: _ Prop. Line _._ __ REPAIR/ADDITION .__.. (Prev.:Sanitation Permit# -------------------------------------------- Date ________.-------------------------1 j Septic Tank (Specify Requirements) -------- --------- -... ------------------- ------------------If,----------------------•- Disposal F- 1 { pacify Requirements) R 3-G a j 0 d '�- s --- ' = -- ----- ------ _ ._�,. -------------- -------------- -------------- ---------------------------- ---------------------------:-- ` r (Draw existing and quired addition on reverse side} t 1 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 signat6re certifies the following: "I certiify that ikAe performance "of the woek"for which ibis permitis issued; I'sh'bll not employ any person in such manner �,,",-a5"to-become=-subject to Work m 's Compensation laws of California." Signed------------ --= -- ----------- - -------------- -- ----- --- -- - Owner By ----------------------------- -------- -------- -----t- - ol- -3itle ----- ---------- ---------------------------------------------------- - (If other than owner) 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B - - ---- DATE �,:3 _ __._ BUILDINGPERMIT ISSUED ----------------------------------------------------------------y-- -- r ----------DATE -------------•---------•---- ------------ ADDITIONALCOMMENTS ----------------------------------------------------------------------------------------------------------------------------------• -----------------------•--- ------------------------------------------------------------------------ -------------------------------------------------------------------------------------------------------------------------------- -------- ------------- -------------- - ----- --- -- -.. --------------------------------- -- ----- -- - ------------------------------------------------------------------ ----------- --------- ------- Final Inspection by: - c.�---------------- -------------------------•---------------------------------------Date ; SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M.