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/�- -APPLICATION FOR SANITATION PE�''"�IY Permit No. _6rI'_aU- __. q — (Complete In Triplicate) NJ ________ __________ __________ 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 CountyOrdi a No. 549 and existing Rules and Regulations: JOB ADDRESSILOCATKr7.lived CENSUS TRACT - Owner's Name � �� ---•-••---------- ------- ----------------------Phone -•--•--•-•- Address ---- City -------------------------------------------------------------•--•--• ---- ------------ ----- Contractor's Name -.-__-- --Et-7U------0= --------- .........................License # _/4&_/d_:i6ZA�Phone Installation will serve: Residence [Apartment House C❑ Commercial ❑Trailer Court F] Motel ❑Other ---------------------------•---------- Number of living units:_________ Number of bedrooms ....Garbage Grinder,4 lot Size Water Supply: Public System and name ----------• ---------- ---------------------------------–----------------------------------------------------Private' Character of soil to a depth of 3 feet: Sand❑ Sift❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 0 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 permitted if public sewer is available within 200 feet, PACKAGE TREATMENT [ ] SEPTIC TANK T j 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 ------___....... .------ 'D' Box ------ -- Type Filter Material ____________________Depth Filter Material --------------------........................ Distance to nearest: Well ------------------------ Foundation ---------.........------ Property Line ..........._._.......... SEEPAGE PIT [ ] Depth -------------------- Diameter --_.-- ......... Number ---------------------------- Rock Filled Yes ❑ No (03 Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -----------_-------. Prop. Line .----•--.----:-------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date .........V.... ...............r-) r Septic Tank (Specify Requirements) ___________-____--U""""'" � -- Disposal Field (Specify Requirements) ---•- f----- �C p�----Xlllli� -----------------------•----------- ----•-•---------- ------------------------ - -- ---------------------- -------------- - - - - - - - ------------------------------------------------------- (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 ----------------------------------------------- - - ----- Owner title -------- ----------•---------•-- {lf other than ow EPARTMENT USE ONLY APPLICATION ACCEPTED By----- - --- ------------------------------------•------------------ DATE ............. BUILDING PERMIT ISSUED -------- • -- -----------------------------------------------------------DATE ------•----•------------------------_-•---- ADDITIONAL COMME TSy________.G_ ____ ___________•-_ _ V1 -- ---------------------------------------------------------------------•---•----------•---------•------- ------••--- _!i / ' •-•-- -- - •------------- -------------- --------------- ------------------------------ ------------- ----%, Final inspection by: --------- - --- ----------- ----------------Date ----- __4 S�OAQUIN LOCAL HEALTH DISTRICT E. H. 9 1268 Rev. 5M