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f FOR OFFICE USE: AP►:ICATION FOR SANITATION PERMIT y �Q.. Permit No. ...J/'.. .......... (Complete in Triplicaic) Date Issued...G/•�..7/ This Permit Expires 1 Year From Date lisued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein j described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: ... JOB ADDRESS/LOCAT N ........�... 1� .... . . . . .. ... ... ... 2%. ............. �.YyS�S CENSUS TRACT ... ta 'u'L. -n. Phone Owner's Name ..`✓ CJ��W !L'L..__ 'k J Address ... � _ /--_.....city ....... // r/ u�.. .. :cense#C25-y-2,3Phone �.C�.:�l .. Contractor's Name.----. ..- '' Installation will serve: Residence❑Apartment House❑ CommerciaOrailer Court j] Motel ❑Other. -•.............................. , i 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 7 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.) r NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK[ ] Size................................................ Liquid Depth .......................... Capacity .................... Type .................... Material.----- ............... No. Compartments ...................... Distance to nearest: Well ....................................Foundation ...................... Prop. Line...................... LEACHING LINE [ j No. of Lines ........................ Length of each line Total Length ............................ p. 'D' Box ............ Type Filter Material ....................Depth Filter Materiel ............................................ Distance to nearest: Well ........................ Foundation Property Line ........................ SEEPAGE PIT Depth .... Diameter Number ..... ..................... Rock Filled Yes ❑ No t. [ ) p Water Table Depth Rock Size ................................ Distance to nearest: Well ........................................Foundation ..................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .... ...................) Septic Tank (Specify Requirements) ............................................................................................................................................ Dis osal�Field (Specify R mentsl +.. z................ .............. .x ..� R ............................ ?111 (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 Sun Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaqvin Local Health District. Home owner or licen- sed agents signature certifies the following: j "I certify that in the perfor rice f flue work for ch this permit is issued, I shall not employ any person to such manner as to be esu o'ect to o ma 's Compensatid0 la s of California." Signed _.........._.. Owner x _ Title .. ..._......__................................ (Ifo an own ) FOR DEPARTMFNT USE ONLY 77— APPLICATION ACCEPTED BY ...`. ��^.` 4. ........-•• DATE . ... `".�.. BUILDINGPERMIT ISSUED ...... .. ........ ..................................................DATE........................................... ADDITIONALCOMMENTS.................................................................._............................_.......---•-.---...........---......_......._................. ..... ................................................................•---..............................._................................................. FinalInspection 6 ---•-.....-�----�•.........................Date ... ..... .._ ..................... G G SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M r_ :