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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit'No. (Complete in Triplicate) _.7..:... ........ ' ,. ....... 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,,,eonstruct�and install the work herein described. This application is made in compliance with County Ordinance°No: 549 and'ezistingRules and Regulations. r � JOB ADDRESS/LOCATION .: .. .. _.--�,-._- --VCt. %'Q f!.°-?.__.�% -'--•........... ....CENSUS TRACT ..................-....... Owner's Name ../G'/"G /p./(f�.... Q• _ �1 .. .•..........•............ ............Phone .................................... i .�-t....................•--- � ` ' at Address - - Contractor's Name .....-- -- rL ..,/ - _kY_ c ............. ..:..... .......License #�!�� ._ Phone ............................... Installation will serve: Residence 59Apariment Houseo .Cornmerciol ❑Trailer Court Motel ❑Other .................:............... ........... Number of living units:--- ..... Number of bedrooms ............Garbage Grinder ------------ lot Size .......:...................................: Water Supply: Public System and name .. .y, ---- ---------------•--•------------------------•-----_.-----Private ❑ Character of soil to a depth of 3 feet; Sand❑, -Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ `.i Hardpan ❑ Adobe % f=ill 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 TANKPQ Size.* _s ....................... Liquid Depth .4.......-___________ t Capacity /Xee7..... Type 01'�1,�.'_ Material. />¢-�V ....... No. Compartments .-Z................... Distance to nearest: Well .----._ -� .................Foundation .. . ........ Prop. Line . ;G .'_...... 1 LEACHING LINE No, of Lines _....�'__......°�'. length of each�line---0.-t;J.................. Total length i._..__..:._. 'D' Box_.�1, .- Type Filter Material Depth Filter Material ....................... j; Distance/to nearest:.-Well.-4T�.--__1. s____ Foundation .Ap..�_.......... Property Line ._14 .f SEEPAGE PIT [�j_ ° Depth _^.e ��`_-_ Diameter s --r•--- Number ..._�____._ -----•_--- Rock Filled Yes)8 No ❑ n Water Table Depth Rock.Size ., ... �'. . -•-------•••••........:....••• -_-_---•--- - e I R �• � 1 Distance to nearest: Weil,=------- t ...................Foundation'. Prop Line . REPAIR/ADDITION iPi . �ermit��..�...•-----�..r.::. - - - ..1_-'-f_-'_,_-_.Date .................................. ..............Tank Seci�Requrement ....._..... f Disposal Field [Specify Requirements) - ............................• -----••••-•........ - - ----------- -----------••--....--••-----.____.._.__..... . --------------------------- ---------- _.._ _Y (Draw existing and required addition on reverse side) A 1 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 licew 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 Callfornia." Signed ` t .._.. Owner By ----------------- ------------ •••••-- ....... Title , f (If othe owner)_ j ORD ARTMENT US ONLY ,a r ` rr APPLICATION ACCEPTED BY - ----------- DATE .._ D"` 4-__".7- BUILDING PERMIT ISSUED ............. .. ...........-__DATE ----.....-- .............................. ...................._..__. ' ADDITIONAL COMMENTS .............. ........... ._.....-.1...---...._. ........ .................-------------------'.-._.......---•---•-• --_._.._.:..._... --...._. . t ...---•- ...................----------- •_......•----•--•-•-•-•-•-•---............. ... ... ........... ........................... . ._ `-`------ - Final 711n, ection by; ..Qate�� _ .................• lSAN JOAQUIN LOCAL HEALTH DISTRICT /l]; E. H. 13 24 1.'68 Rev. W 7 1 77 14 W