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FOR OFFICE USE: (; C- -, ;/L•�, -i-/ e S Ir APPLICATION FOR SANITATION PERMIT =�1 ------- - � Permit No (Complete in Triplicate) . .�__ --------------------------- / ----------------------------------------------- ---- 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 _Z75,-3 -------------------------------------------------------------------03A o _CENSUS TRACT __1� _ ------------------------------------------------- ---------- T©CiG TOr�I----+�El - -L r2 r�----i✓G `°`�=------------- Owner's Name Phone . - - - - --- - -- wlCa . J City-----"Address --- -/-fA--------------�=[��-------------•--------------------------------------- ,/-----------------•--------------------------- -- Contractor's Name . _�_Ffq/Z/Zt s _______f,=_--, r. -- ------------------- - S-- 5. . evC License # ----- ------ ---- Phone ------------------- ---------- Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑ Other ---ca _.�_7 ti:_a'r Number of living units_____________ Number of bedrooms ------------Garbage Grinder ------------ Lot Size _____-_____---_-______._.__---•--__-_-____._ Water Supply: Public Systerrr 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 permed if public sewer is available within 200 feet,) Iti e� ---_ Liquid Depth __- 7 PACKAGE TREATMENT `� SEPTICTANK„)(J Size____.________________.__ ________ ____________. CapacityType -------------------- Material---- ------------- No. Compartments .......... DistaDistance nce to nearest: Well ---------------------Foundation __.- _______ Prop. Line ---------------7...... LEACHING LINE No. of Lines ----- _ Length of each line-------- Total Length ----XP6................ 'D' Box __-- -_-_ Type Filter Material _____---__--_--_Depth Filter Material __---___------------_______________--.__.. Distance to nearest: Well -------- Foundation ----:;��------------ Property Line ----/_�-'L SEEPAGE PIT [ J Depth ------_.._ ------. Diameter ----- ---------- Number ---------------------------- Rock Filled Yes ❑ No i❑ Water Table Depth ---- -------------------------------------------Rock Size ---•---•--•--------------------- Distance to nearest: Well ________________________________________Foundation --------------- ---- Prop. Line ____-____-______-___-- REPAIR/ADDITION(Prev. Sanitation Permit°# ____________________________________________ Date ----------------------------------) SepticTank (Specify Requirements) ---------------------------------------------- -----------------------------------____----------------------.-------------------------•- w 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: "I 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 Workman's Compensation laws of California." Signed --- ----------•---- Owner BY ` - _ - -• / - ------ Title ------- '--------------- - - - (If other t an ow r FOR DEPARTMENT USE ONLYE -Lk / APPLICATION ACCEPTED BY --------------------- I �fl ---------------------------- --------------------• DATE -- �-F�� T----•--------------- BUILDING PERMIT ISSUED -------------•---------------------------------• -----.----• -- --- ------ -----•- - -•----DATE -------------•---_- •----------- ADDIT NAL CO TS c Vit ? f ---------- c � L- - ------------------------------ ------------------------------------- - --- --- -- - --- -- ----------------------------------------------------------------------------------- -- ------- Final Inspection b __-_-__-__ P Y - Dae = -(1 4 SA JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M