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' FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------•--------•--•---••---------•----... Permit No. _. (Complete in Triplicate) Date Issued This.Permit Expires 1 Year From 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.Na. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION . I� ►�y 3+'d -- - --- SUS TRACT .P2_5'--o•b�V -cin"' Owner's Name ---------/_ _,�s ---- �-----•---- - Phone .............................. e Address .......... Q, ........... - --------• City _ Contractor's Name �"e. '�-'''�' P-.....License # j ,�. Y.._.. Phone :.. ' Installation will serve: Residence ❑Apartment Ho se,❑ Commercial' Trailer Court ;❑ Motel ❑Other_Gr -�J!! t��► ! Number of living units_.......... Number of bedrooms ------.__-__Garbage Grinder ............. Lot Size ............................................ ..................................• Private Water Supply: Public System and name ..-_......._.-•---------------------------------------------•.••.-.-. 6N Character of soil to a depth o13 feet: Sand ❑ Silt❑ Clay .❑ Peat(:r Sandy Loam-❑ Clay Loam'❑ 4 Hardpan ❑ Adobe-0 Fill Material ............ If yes,type ----------------•-_---_---._ (PI'ot 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'[ ] Size4 . Liquid Depth�......................`� ��tt,�,,Q�% T e ; :.- Material. -r/k ---------_ No. Compartments _ .°_.--_..:.__�7� Capacity�_°g:r� Type Distance to nearest. Well ._S_.___._iiQ .................Foundation .....1.l�._._...-... Prop. Line................_...... N No. of Lines ........3---_-------;•.Length of each line---------1-o.O-•-.---... Total Length .._. -------••--- , /6)lAptz D Box .._ Type Filter Material .... -----••Depth Filter Material ........... ....................... f7 eo 1, Distance to nearest: Well ....._..LOP..._--_ Foundation .---�-------------- Property Line. - �--------•_-----•. '� SEEPAGE PIT [ J Depth Diameter ................ Number ............................ Rock Filled Yes 'Q No a' Water Table Depth ---_------------------------- ----•---------- Rock Size -------- ----------•---- Distance to nearest: Well ........................................Foundation •.._......_ ........ Prop. -Line ..... -------_------ ' REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------•------------------------1 �,='.: Septic Tank (Specify Requirements)' .:: '_': Disposal Field ((Specify-Requirements)--..-,----.--.--.-'—-"- ' � '" .------..... ................... F ._.. - - -----•--•••• w ...., 46.,- fg ' q the work will be done in accordance•vent ------------------------- -------- --- - ••. . . . ---•--• -- ,. ' I a (Draw exist In and required addition on reverse side) I hereby certify that-1-have prepared this application and th at h San Joaquin d County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner.or licen- sed agents signature certifies the followings °`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 ----------- -----(if_. ------ ..,.an-_ -----..._.. .................. Title .._ .Q¢ 9 ..�----•-. ............................... {If other than owners ... _ •- - - ` FOR"'DEPARTMENT'USE-ONLY' ' ' APPLICATION ACCEPTED BY . . .C�- '� .._... ....................................... DATE .✓-_z. -.. �... ----- BUILDING PERMIT ISSUED ....................................... ....................I.............. ----••..._..--•---....... DATE ADDITIONALCOMMENTS ........................................ ............ ...................... ----•- .................................. =---------------- --------- ----------------------------- ---•--------••--•-----..._.... -------------•-------•------------------•_---------------------- ------ .----- -- --- ................_......_ - - - ------ - - Final Inspection by- --------- - ...............................................................Date ✓`'Z b SAN JOAQUIN LOCAL HEALTH DISTRICT E.H. 9 1-'68 Rev. 5M