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o I FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT c/ ........................ ....• Permit No. 3....4.g. i -. (Complete in Triplicate) ..._.. This Permit Expires ] Year From Date Issued Date Issued q.".JL. "...... 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. u i JOB ADDRESS/LOCAT N > 1. .-C.f-��!k _..-� ZP: ......CENSUS TRACT .. .. . ..--. ....... Owner's Name .... Y. ._.... Phone . �. Z. Address 34------------ .... City ............................. r .. = Contractor's Name ........... - .... --- ...' .... .......... '.License # - .: _ Phone ........... Installation will serve: Residence Apartment House 0 Commercial OT,raller Court ❑ Motel ❑Other ' I ................. Number of living units:.._...... Number of bedrooms .. ......Garbage Grinder ............ Lot ize .... 1............... Water Supply: Public System and name ..........-........................................------....................._ ........................Private ❑ - °•`Character of soil to a depth�of 3-feet:— Sand-0--7Silt E]77 Cla-y'-❑'—Peat O-'--'Sandy Loam 0 Clay Loam • is Hardpan ❑ Adobe DC Fill Material _.._. ...... If yes,type •___________________________ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverser side.) NEW INSTALLATION: JNo septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK Size------. .._.. ........................ Liquid Depth S.y..........,...... - f � Capacity) .. Type 941--$ . Material___4 'yl .�_ No. Compartments ......................S f � Distance to nearest: Well ...............4....................Foundation .. Q.....__.._... Prop. Line .r- LEACHING LINE No. of Lines Length of each•I ne.�...4.0.r.......... Total Length .��............. � 'D' Box ✓ Type Filter Material . Depth Filter'. Material -�r r r - ... _..... Property Line Distance to,nearest:•Well•....:-:................. Foundafiion �_:;,lD_.t'.. ."'"_-_•--...-. SEEPAGE PIT Depth Diameter 1. . Number ..i......... . .......... Rock Filled Yes 0 Na Water Table Depth ..............'..............------- 4..: RocicSize ...........-...... Distance to.nearest: Well ..!.Foundation _ Prop. Line REPAIR/ADDITION(Prev. Sanitation'Permit# ................ ............... -... Date .................................. Septic Tank (Specify Requirements) -'- ........ I-—. .....•........:V DisposalField (Specify Requirements) ---------- .......................................------............................................................................. -------------------------- ------------------------------------ ------------------•-•-------..................--•----•-------•-•. . ( --••-..... •. •------- -•--........_.:. I�..w....��.' -------------------•---.....................----_.-•__ _........_.........__----"-'---._._.._........_...._..................._...._._.................................-:_...._....__.......... (Draw existing and required addition on reverse side) { J � t I hereby certify that I have prepared this application and that the work will be dons in accordance with San Joaquin County Ordinances, State Laws,,,ancl 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."- - m Signed . e -- A. - • Owner A(If o t h t on owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ......., DATE BUILDING PERMIT ISSUED ..................................................... ,......:----------- ......DATE ADDITIONAL COMMENTS ............................................................................................................................................................ .. .......................... ......... ......................:........................... ..... ...................._....................................... ............................ ._.•......................................................................•-•••---•• ---••---•-•-. ••-•-•-•-•-••.......:......... -----. Final Inspection by: ...:.............................••--...-- .. ; :.. ¢ ..Date ...1�� ._..... y SAN JOAQUIN LOCAL HEALTH Dl_ CT L F_ H_13 24 I.-AA Re,. 5M 7/723-m