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FOR OFFICE USE: .�,,'LICATION FOR SANITATION PERM,,. — - - ------- - - -- --------- -- (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 hereir described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: '- JOB ADDRESS/LOCATION 5�'S1��-------�.--- --'- ---��----.---..---_.-_..___._ CENSUS TRACT ------------------------ Owner's Name ----C. 4. :-` Gt _..> cJ---- - -- - Phone .------ ------- 22 Address ------% /�Gl City L-�__� rr1-z ---------- ------.------ Contractor's Name . -� f - ��- % `.License # �� y Phone Installation will serve: Residence Apartment House❑1 oommmercial []Trailer Court :❑ Motel F-1 Other _.-- Number of living units:--------- Number of bedrooms ----.-------Garbage Grinder ------------ Lot Size .----------------.........___-..-_-- Water Supply: Public System and name ------ --------------•----------- ----------------------------------- ------------------ --------------------Private,'. Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ 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 pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK Size_ - -.Y___�.---__._.__-._..._ Liquid Depth 1571.____________________ - r Capacity5; d ...1, ype --------- _ Compartments.Material.-_ � -� ___ NoCom • r p J 5 a .................Foundation ------�O / Distance to near t: Well ._.._. _ __ ...-.- Prop. Line ___.�_. __-_.___.__ C LEACHING LINE [ J No. of Lines ------ -Cl? -- Length of each line.------- _.._ Total Length __ _Q_� -- Ul 'D' Box -----/----- Type Filter Material _-.-__S �----Depth Filt Material ___.__��j.'______________________________ Ul ,- Distance to nearest: Well ___._.�__,�a_k;,, Foundation _.__.__I-Q. __ Property Line _.S _-.� !� ZSEEPAGE PIT Depth ___ ._ Diameter _f ---_-___ Number -__. Rock Filled Yes j�No UJ Water Table Depth ---------- 4_ ._ __`_ _____________Rock Size Distance to nearest: Well --- Foundation _.1C? Prop. Line --- / REPAIR/ADDITION(Prev. Sanitation Permit# _______....__...____/_.._..____._______ Date _.______._._____________------- ) Septic Tank (Specify Requirements) ---------------------- ----------- ---------- ---------------- ----------- ---------------------------• --------- ---------C� Disposal Field (Specify Requirements) -------------------------------------- ------------------------------------ - ------ ------------------- ------------------------ --- -------------- ------------------------------- ------- --------------------------------------------------------------------------------- --------- ------------------------------------------------ ------ --------------------------------------------------------- ------•� ------------- ------- ---------------....----------- - -------------------------------------•---- --------------------------------------- ----------------- ----------------------------------- (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: "1 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 become subject to Workm s ompensation of California." Signed ------------------------ - ----------- -- ----- Owner B _ f� (� ' C ------- Title Y - : (If other th-_ caner) / FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY r � - -- -- ---------- ----- -- - - --------- DATE �'^-� c::_1:.�..�>.1------------- BUILDING PERMIT ISSUED -------------------------------- ----------- ------------------------------------------------------- --DATE -- --------------- ------- ADDITIONAL COMMENTS ---------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------- - --------------------- ----------- ---------- --------- ----- ---------------------------------------------------------------------- - - --- ------- ---- - Final Inspection by: - - ---------------------------- ----------------------------D--a--t-e-- -------------------------- Date ..- -�`�-/---- � --------- N JOAQUIN LOCAL HEALTH DISTRICT U n i•-,Lo o_.. rAA YM zf.