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rt FOR OFFICE USE: ---------�--- ----------------- APPLICATION-FOR *SANITATION PERMIT i --- ---------- _7.Z----�--� • (Complete in Triplicate) Permit No. Z�o ---------=----------------------------------------------- Date Issued --------------------------------------------------------- This Permit Expires i Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: 235- ... JOB ADDRESS/LOCATION .- - --j___I- IQ�1Ii -----L-N'_-- -- -----------------CENSUS TRACT -------------- ------- I4- --3-Ka- Owner's Name ----UJ--`-------�-6�--� � �'�.------�-•-----------•---------------------------------------------------Phone Z S- Address - ------ --------- '---'� �;� ` ` -- - -------------------------------------- City -Laal-------C I------------------------- -• Contractor's Name ------------------------------------License #/67015,14---- Phone -,-- _ ---- - _ Installation will serve: Residencepartment House❑ Commerciale❑Trailer Court i❑ i Motel ❑ Other -------------------------------------------- Number of living units:_.__t______ Number of bedrooms _ C�_�__#_ Lot Size _�- -------- ---------_ ____-__Garbage Grinder __ �(,7 � - -----------•----- Water Supply: Public System and name ----------------------- ---------•---------------------------------- •-------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat ❑ Sandy, Loam K Clay Loam Hardpan ❑ Adobe ❑ Fill Material ---------- If yes, type ________________________ i 1 (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,) a PACKAGE TOtATMENT [ SEPTIC TANK -- ------- q p r� ___._____ Liquid Depth Capacity/_200 4_ __ Type Flt-C- t Material__; 110u No. Compartments Z7--7=.......... Distance to nearest: .Well ._/_ Q-------------------- Foundation Q Prop. Line ---------- ----------------- Length of each line--_- Q..- .----_� Total Length -A-4-0........_. LEACHING LINE [ ] No. of Lines g i I i ' _ 'D' Boxp7�TType Filter Material jZ'—Q—__ �Septh Filter Material _PT-11_________________________________ Distance to nearest: Well __1-OO .......... Foundation _1. ----_---- -- Property Line ._________________ SEEPAGE PIT [ ] Depth _ _________________ Diameter ----------- Number ------ -------'-----------1__ Rock Filled Yes ❑ No Water, Table Depth # ; -----------Rock Siie ----�-------'- Distance to nearest: Well _____________________________-_________Foundation ____.___----------- Prop. Line ---------............ I REPAIR/ADDITION(Prev. Sanitation Permit,# ------------------------------------ ------ Date ---------------------------------- Septic ---------------------------------Se tic Tank (Specify Requirements) a Disposal Field {Specify Requirements) -----------•--------------••-•------------------ ---------------------------------- ----------------------- ----------- --------------------------------------------- ----------------------------------------------------------------------------.------------------------------------------=--- -------------------- 7 r -------------------------------------------- -------------------------------------------- ----------------------------------------------------------------------------------- ------- (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: % j r 4 "I certify that i he performance of the work for which this permit is issued, I shall not employ any person in such manner as to become su ect t$ Wopman's Compensation laws of California." '1 Signed ---- -------- ----- - -------- ------- - Owner By ---- = `' ..... -------- ----- Title (If of er than owner) FOR REPARTMENT USE ONLY APPLICATION ACCEPTED BY --------- -._ - -- ------------- DATE -----2------- BUILDING PERMIT ISSUED ------------------- - -- `-____-- --------------------DATE --.----------•----- ------------------------ ADDITIONALCOMMENTS ------------- ------------------------------------------------------------------------ ------------------------------------------- ---------------•----------- t -------------------------------------------- --------------------- ------------------- �' i . - ------------------------------------------------ ------------------- ------------------------- -------------------------------------------------------------------------------------------- I ` Final Inspection bY: :---------------------------.Date -------------------- ------------------ o- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M