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FOrOFFICE USE: Y: APPLICATION FOR SANITATION PERMIT (Coniplete in Triplicate) Permit No. ........... ...... ......... This Permit Eztiiies,l'Year FromI Date lsiued Date Issued(_.S._/ 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 complia-n•-c}e, with County Ordinance No. 549 and existing Rules and Regulations. JOB ADDRESSAOCATION -- .'� �' ._ ...--.-'I- 1-1�- '-•._...... ----4 _. ` 1 ..................................CENSUS TRACT .................__. ._.._ Owner's Name . _�. u5. V.L ►r. _h5.-.-_----------_---------------------------------- ---------------------Phone Address ;I, -. City v \ Contractor's Name ....)a C?.LXA_✓y--- -- ------------- --- ------ ---------------------license # ....---.- . .... Phone ---•------ ................... Installation will serve: Residence [�9 Apartment House[ Commercial ❑Trailer Court j Motel ❑Other --- ------------------------- Number --------- -- ---------- Number of living units:-. ....,_F,. Number of bedrooms __,j.----_Garbage Grinder .--.-.--.... Lot Size .................................... Water Supply: Public System and name . .. 1 ----------._.... -•........................•---....---- ---•------......--------..Private ❑ Character of soil to a depth of 3 feet: Sand E] Silt❑ Clay ❑ Peat Sandy Loam ❑ Clay loam ❑ Hardpan ❑ Adobe X Fill Material ___........ If yes, type ............................ {Piot 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 [ j Size.........._........ ........................... Liquid Depth .....----...--............ Capacity .. .. Type -------------------- Material---------.........._.. No. . Compartments -----._.---_. Distance to nearest: Well ._. ..-_---..--._------Foundation ...................... Prop. Line .------•----......---. r `; LEACHING LINE ( ] No. of L�hees Length of each line.-......................... Total Length ....._.-...-•-------•--•-.-• r 'D' it Box ._.... Type Filter Mat 7. �� Depth Filter Material _ yP - Iel..............••-----••--•-------- Distance to nearest: Wel! .._..'�:----_-.._ Foundation .�a_. t....... Property Line _....✓fi r..... SEEPAGE PIT { ] Depth' ., .�.., Diameter ._---------- Number .._...... .... .............. Rock Filled Yes ❑ No C) S' ater` Table Depth .... ...................................Rock Size -------- ----•- ------ Distance to nearest: Well Pik....................................Foundation Prop. Line ---------_------- -- REPAIR/ADDITION iPrev. Sanitation Permit# ----_-_ .. Date ..................................) 9' Septic Tank (Specify Requirements) .... .. 9t.qt7 " 5--�- fil.-L-- `q V1 .---f- + ._........ 10 .fit Disposal Field`,(Specify Requiremments) - ---____-- _ -- In - ---...- - ....��...-.:.D-'...... ._.... ......................... ............ .��. ._. ................. ---------------- •------...----------------------------------- - ---- - _..------------.----._.-._...--. ....-._-..._..:--------•-------------- 11 (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: e�"� � } , "I certify that in the performance of. the':work for which thls`permlt,is issued, .I shall not employ any person in such manner as to become subje to orkrh ` 's Co pensation laws of &114'ornia" ` . _<. ... �. 1J1. Owners e Signed n ... a By . . .. ......... �. .,. ?_...._...... Title�,a , (if atlierthan owner) _-FO EPARTMENT USE.;ONLY �,, t APPLICATION ACCEPTED 8Y�_ _ - -_-•- ...... __... ...:................... ... DATE BUILDING PERMIT ISSUED -..- .. ._. /_ l DATE - ............ ADDITIONAU,COMMENTS k ... . ».: _.. .,. rs h� .. . -. R �� ...-----•-----------............... ..__...... .................................... _. :---..------------- t" ) , ...---�..Y--- ----------- ----- ............................ �_ .. = - Final Inspection by;" t i :'1 ate ... .. :. ..... D . . .. 7 SAN ,JOA.QUIN i.O&L HEA` H.,DISTRICT m . o � 't E. H. 1:3 241_'68 Rev. 5M _ 7/-72,3 M:,- ,.