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FOR OFFICE USE: - " APPLICATION FOR SANITATION PERMIT ..................................------------------- (Complete in Triplicate) Permit No: �... 1 Date Issued -- •-�-•z- - �� ............................................. 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 No- 544 and existing Rules and Regulations: JOB ADDRESS/LOCATION .__.______-_g a .___ __ ------P _ _____CENSUS TRACT ______._____—----------- -----------------=---------- > Owner's Name ------ ------------------ - ---------- L�. _ � --- PhoneQ.2_-_A1�1 Address - -------------------- 10 , 9_;r om- City_ �p y ----------------------.License #/G��L/---- -- Phone ------------ Installation Con#radar's Name ___________ . _ -_ __ , Installation will serve: ResidenceVApartment Nouse❑ Commercial'❑Trailer Court ,❑ Motel'n Other ---- ------------------___.............. . Number of living units:.....(---- Number 61,bedrooms _-Y<..Garbage Grinder ............ Lot Size .....f�.�- -�_L&a...__.... Y Water Supply: Public System and name ......................... ................................. ......................Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ [Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan 0 Adobe"Fill Material ----------- If yes,type ____________________________ (Plot pian, 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( Size_______________ ------------------ Liquid Depth ___, "f.__---------:___. -4 Capacity?-' ?�_ Type - .-. .. .. Material.�dr�_.-:E_ No. Compartments Distance to nearest: Well _- _-. .f"`. ............Foundation ._._ Pr"op. Une __ ....r._ .... ..; LEACHING LINE No. of Lines ------------------------ Length of each line------.. ----- Total Length ?a................% ' D' 'Box'._...-.--... Type Filter-Material . ...-Depth Filter Material --../............. Distance to nearest: Well ---->V-r:�....'Foundationr 7...... Property Line. ..... ....,-,e........ SEEPAGE PIT ] Depth ____2_�________ Diameter. Number # 5__ ____________ Rock Filled Yes j No'C] { 1/3 i r Water Table Depth, `;' ----------- -------• ------->------ --Rock-Size '1-y----------------------- N` Distance to nearest: Well _-__L _-_ __ ________________Foundation Prop. Line ... 1 � I REPAIR/ADDITION(Prev. Sanitation Permit# -.------- --------------------- ____ ____________3_____________ Date _________________--___-____-____) Septic Tank (Specify Requirements) _ Disposal Field (Specify- Requirements) -----------------...--....-`-.....-------------------- -------------- -------------- .............. (Draw existing and required addition on reverse side) I hereby certify,that,l;have prepared this application and that the work will be done in accordance with San Joaquin .Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen County Ordinances, State sed agents signature certifies the following: f "II 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 ---------- -------I--- ----- -- ------------ -- -------------- ------------------------------ Owner ; By -- ------- ------ Title --------- [if other owner) -FOR DEPARTMENT USE'ONLY APPLICATION ACCEPTED BY ------------------- ------ ' -' = .... -----------•-------•-------_... DATE �d BUILDING PERMIT ISSUED . v ti DAT - -------------- ,.� ADDITIONAL COMMENTS . a�f7/....L 4 .��:�3'``a.� _.`1 v .��2.e"? _/-----...._�f�_� - ------ ------------------------ Final Inspection b -_---- - / _ A Y --------------- -Date * � ------ ir SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 968 Rev. SM