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FOR OFFICE USE: I ` y JAPPLICATION FOR SANITATION PERMIT I _ ----- -- Permit No. (Complete in Triplicate) f ' --•------•----- This Permit Expires 1 Year From Date Issued Date 1,ssued .11...:-_�Q..-? Application is hereby made to the San Joaquin Local Health District for a permit to construct and install therwork herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules cited Regulations: JOB ,ADDRESS/LOCATION ._.? rl �__.!:-;: :,- /' / .�f.s .;��`_._,.� `�_ .. CENSUS TRAul -----------------_...... Owner's Name �?'!Jw!'_ <..t 'ff ., _Phone': � ........................ J f l �I Address -V_'==..................................................... City ------------- ------------------------ Contractors Name -_f.. .`.. :....__.e rr_.._-- '--------. :----'---------------_License # ,_ c ' ---z--- Phone...........f..:.__-..... --- Installation will serve: )� Residence ]`Apartment House❑ Commercial ❑Trailer Court C i Motel ❑ Other •••••--•-••.... . . .. ...... .. . Number of living units: / Number of bedrooms _-_.�3__--Garbage Grinder -/I.��"' Lot Size -:-'._:.'.: !'f_.•' ...... ._-__.-__ Water Supply: Public System and name _____________________--_.-------d__._ ........ ....... Private []' ------- ._ . .__.._..._..- -•--•-------------- �G Character of soil to a depth of 3 feet: Sand [jSilt[I Clay ❑ Peat E] Sandy Loam C] Clay Lbam ❑ Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type '.�I• (Plot plan, showing S ize 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_f......t__.._'... ---_.__.._.- Liquid Depth .:�1___.__.__________ ,. -- - CCopaci 'f:+YT �' _l� ' � Material:`'�' '_y' ', No. Compartments ants apacity Ype p _<.............. Distance to nearest: Well __-_ ....-.Foundation ---.. ...... .___ Prop.�ILine .............. LEACHING LINE [ ] No. of Lines -_______--_- - Lengfh of'each line ?`- i "--%.l. Total Length! _/....................... 'D' Box '.-. Type Filter Material;t- :�" f`'-_____Depth Filter Material _r_l. _____________________________ • .ih _. Distance to nearest: Well -r-F- Foundation __._ �.f~"__._-__-____ Property Line ....................:.... SEEPAGE PIT Depth ' .-.- Diameter Rock Filled' Yes Q No i❑ rWater.Table .Depth-___-: ' '.' __-___--_-:_l_________________ Rock Size ... .._� Distance to nearest: Well _.Foundation ......_....... a �:..:.-• ---=--•-------------------- ...-_ Prop. Line --�'------------------ REPAIVADDITION(Prev. Sanitation Permit# _________________ -------------- - _---_ -:- Date[-. ---------- ___ -_-____-._____-) Septic Tank (Specify Requirements) ' - Disposal Field (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. Hoche owner or liven. 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 persl n in such manner as to become subject to Workman's Compensation laws of California." Signed �`--__: _ _-_ Owner By ` it - .-._. _..r.:..._..-"--- -'-- - ------------------ --- -- Title .......................°---------------------------------- --- (If other than owner) PARTMENT USE ONLY APPLICATION ACCEPTED BY ...._.. ,/ .--- .._ . - -- ------------ DATE ............. ---- ----- ------- ------ -DAJE ...----'l -------- BUILDING PERMIT ISSUED -- ADDITPAL COMMENTS Q ..4 -- --------------------------------- - ----- -------- - --- - --- ------ ---------------------------------------------- ---- - ..Date Final Inspection by: - ----- - --- -- -------•..............•___•. SAiOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.