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FOR OFFICE USE: it ! APPLICATION FOR SANITATION PERMIT .... Permit�N Permit No: ...7y... .. (Complete in Triplicate) .............. �� Date Issued ..................:. .............................. This Permit Expires 7 Year From Date issued Applicationis hereby made to the San Joaquin Local Health�j District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: l JOB ADDRESS/LOCATION ....../.. .• -... ,.�/ '"`'` CENSUS TRACT ..:....................... 1111._. ` _ .... Owner's Name .......Phone . ..........1111................... •-- Address . /' .�'-�-• -� •`1111. '. Cityr... ....... ............:. _... 1111 1111._. r _ Contractor's Nome . .�� e -..,sera •'.&,��1-•License # o� ° �. ..... Phone Installation will serve: Residence XApartmentiHouse❑ Commercial❑Trailer Court 0 MotelC]Other ...... .................................... Number of living units:../---. Number of be rooms ....Garbage Grinder .-E -Lot Size ... - 'r i Water Supply: Public System and name 111:1. Private ❑ ..u :.-- Character of soil to a depth of 3 feet: - Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam -] Clay Loam ❑ Hardpan ❑ Adobe X Fill Material -----------_ if yes,type ........... ................ A (Plot plan, showing size of lot, location ofr system in relation to wells, buildings, etc. must be placed on reverse side.) t NEW INSTALLATION: (No septic tank or seepage pt permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ] SEPTIC TANK ]&KfS7`�Siae................ ............. Liquid Depth 111....................-• Capacity Material...................... No, Compartments ...................... r w Distance to nearest: Well 1111 I ----------------------Foundation ...................... Prop. Line ...................... N / IIv LEACHING LINE � No. of Lines _.__./................. Length of each line.--,OV�-.3-••..-•------ Total Length ................ 'D' Box ... Type Filter Material _.A0iV ......Depth Filter Material ..., • ................. Distance to nearest: Well Foundation ....� ._.......... Property Line ._. ................ .t t - SEEPAGE PIT Depth .-c .f..--- Diameter :7........ Number ......./............ ...... Rock Filled Yes jk No if- 1 ,��% °z • Water Table Depth .1111...: ------. Rock Size �Ift � �U Distance to nearest: Weil- �" ..Foundation .................... Prop. Line .__.�......_...___... {O ...................1111..---• ---- REPAIR/ADDITION(Prev. Sanitation Permit# -•---._,..------._lp..,--------------------- Date .......:.......................... } t Septic Tank (Specify Requirements( ...................__ Disposal Field (Specify Requirements) . „� C. ...... ... -- - ` � . ✓4 ......... ... ----------------- ----- .................-.............................f---......-------------------------------------------------------------------------11.11................- I (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be don* 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 whichthispermit is issued, I shall not *mploy any person in such manner as to become subject to Workman's Compensation laws'of California." Signed ---- -------------- -......... --•---•-•--- ........- i................. Owner Title BY . . - � (if other than owner) �I R DEP' MENT USE ONLY ... .:. :, ............. -------- •..............•-•-•--.. DATE APPLICATION ACCEPTED BY 11.11. ......... .. ... •- BUILDING PERMIT ISSUED ....... .. .......................................DATE ..........---•--...---•--•--••-.........- ADDITIONALCOM c. :1111. ... •--•-------•---•...................................................•----....:.................. ...... ��. .. ._... . •. ------ -------- --------- ......... ------ --...•- Final inspection by: .' 'p... Date .-�.45- . _.. ...... ..•1111 - - - - -- ••--•---••----.1111--------------------------- ii N JOAQUIN LOCAL HEALTH DISTRICT 7/72 3:X F N 13 24 1.•AS Rev. sM I —_