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FOR OFFICE SE: APPLICATION FOR SANITATION PERMIT _1�"- f, (Complete in Triplicate) Permit No. G -- 3"_5 ----------------------- r S J. - - This Permit xpires 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 County Ord' nc No. 549 and existing Rules and Regulations: JOS ADDRESS/LOCAT - TRACT --------------,•----•_---- ,,Q� CIL ----------Phone Owner's Name --- --- ------------------- - - - ----- Address ----------------- ---- ---- --- - -- y ----------------------------------------------- Contractor's Name --------- ------------ Ah License # (� one - ........................... Installation will serve: Residence partment House f] Commercial ❑Trailer Court i❑ Motel ❑ Other ---------------------------------------•--.. Number of living units:----- __ Number of roo _ _____Gar Gri dg� __ Lot Size __ --� --- --- Water Supply: Public System and name ---_- 2__ ---------------'-----------------------------Private ❑ Character of soil to a depth oft feet: Sand❑ ilt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ AdobeMaterial 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,)d Size___ . . .. - Liquid Depth ------ Id-0 -- - ��-- Capacity _� ____ Type iC ,_ Material�h_C r&�- No. Compartments ________________ "-- ----------- - Foundation S"/ Distance to nearest: Well __________ . �fd_.------_--- Prop. Line -----------------•-••- LEACHING LINE No. of Lines --------- _ Length of qach line --- - Total Len th -C2a 'D' Box ., _._ Type Filter Material __1f ��hQ Depth Filter Materiall _{�_____________________________ Distance to nearest: Well _----7'=-_______.___ Foundation -_AV_/_____________ Property Line __ f SEEPAGE PIT [ Depth _ _:_1 f Diameter __. ___,__.._ Number --------j------------------ Rock Filled Yes [;jj—No i❑ Water Table Depth -------- _,!�--s------------ -------Rock Size --- -------------- Distance to nearest: Well ---------"- -----------------I-___________Foundation ____ ---- Prop. Line ---z$��...... .... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date _____________-_____..___--_-_.__} SepticTank (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. 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'sholl not employ any person in such manner as to becom sub ct to W s CATpensation laws of California." Signed fl Owner , --- -- ------- - -------------- - BY - -- Title -- ----- (If other than w r) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------- --------------------------- -----. DATE -----9'__7AS_ 6�---------- ------------------------------------- - BUILDING PERMIT ISSUED :.:-". = __= = " - -__...DATE .------------•----------------------------- ADDITIONAL COMMENTS ._io � � - %t y .� -,.�`•--'�'�------------� ---------------------------------- -- ----- /as� ..l^7� -�c__ ' i.G a1C E£�------------- -------------------- -----------------------------------------Ap ---- -- --- ----- -- ----------------- v� ------------------- --- ------- - - - Final Inspection by -- -------�------- ----------------------------- ------------------------ ---------------Dote ----- SAN --SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M