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FOR OFFICE USE- APPLICATION FOR SANITATION PERMIT r. ----- ---- --------------------------------------- Permit No: j (Complete in Triplicate) 1 ------------------------------ -------------------------- �( a ThisPermit Expires 1 Year From bate 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 ---!_yy`97-- om --_- -- ----------- - ------ -----CENSUS TRACT __- :--_-- Owner's Name � `*�M_ .te r-- cis, Phone ------- r. Address _ 9 - - * *-.�--(----------7---°--`- ------- ----1�" Citv. . �--------3--- -------------------------------------------f ' � . ^----.License # _j _ Phone ---------------------- --- Contractor's Name -------- Installation will serve: Residence..4 Apartment.House❑ Commercial.:❑Trailer,Court-.i❑,.,.. Motel ❑ Other -------------------------------------------- r Number of living units:____I____ Number of bedrooms- ___.Garbage Grinder ----_--__-_- Lot Size ________________ _________________________ t - � Water Supply: Public System and name ------ - ----- ------- -----3_____�c� -----------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat F.].—Sandy Loam . Cldy Loam El Hardpan ❑ 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,) t Size-� �~� t _�t_ - Liquid Depth - Size-0 � PACKAGE TREATMENT ] SEPTIC TANK ----- ----- -•----------- T e R Material___ ~-� _ N. Compartments ---------- Capacity YP YC p Distance to nearest: Well -----------1__Q_ ?__'____________Foundatibn _�_f o_r___________ Prop. Line ------ _____._--._. LEACHING LINE No. of Lines _________�_____________ Length of each line ' --! -- �-��_ Total Length ......14 ---__..__-___- Vx i �r ----------- 'D' Box __^r^--_._ Type,Filter Material _____ ___R_� _.Depth Filter Material ----------1_�L_ _____ _--____._ Distance to nearest:;Well -1__0b_"- -•Foundation _-L_ :__:___ __ Property Line ___S________________ (�} Depth ____ �--------- --� - -- -__-'___k_ Rock Filled Yes �' No C3 t �__xY�`�_ Number------------- Water Table Depth -----------------4_0_11--------------------Rock Size ---j ------��------- Distance to nearest: Well _________ ___t___________________Foundation -----L_0---`----- Prop. Line ------ -------- REPAIR/ADDITION _.._-REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -------------------------.--------) � Septic Tank (Specify Requirements) ---------------------------------------------------------------------------------- --------------------------- ------ DisposalField (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------------------- 1 ---------------- --- - --------- --- ----------------- ---- ------- --- -- --- ----------- ------------ (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, 1 shall not employ any person in such manner 1-44 as to become subject to Workman's Compensation laws of California." Signed --- ------ --------- Owner BY ----- Title (If other than owner) FOR DEPARTMENT USE ONLY'--�" APPLICATION ACCEPTED BY --------------------------------------------------- __ -----------. DATE /V- s _-�°.r' . BUILDINGPERMIT ISSUED ---------------------------------------------------------------- ----------- ------------=--- ------.---DATE ------------------------------------------- ADDITIONAL COMMENTS ----------------------------------------------------------------------------------------------- -------- ------ ----------.---------------- --------------------------- ------------------------------------------------------------- - --------- -------------------------------------------------------------------------------------- ----------- -------------- --------------- --- --- ------- ------------------------------------------------ ---------- - - -- ------------ ---- F'rnal Inspection by Date _... SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M