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OFFICE"[15E: APPLICATION FOR SANITATION PERMIT �. ,.. 6 •� � � Permit No. ...........:........: (Complete in Triplicate) N :...................................................... t Date Issued ..,K,: ..-�� ......................................................... 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. 549 and existing Rules and Regulatidris:, JOB ADDRESS/LOCATION ......�..f---�_Q.P..L,/j,&�...................... ....CENSUS TRACT ....,.-�.._..-'.�_. . �, Owner's Name ...... 7` ,�r. ................. - -----------/--�-------------------- -- - -- --.._..._................................:.........._.__._.._..Phone -------•---• ,� Address ............... '�_�.. L -c�r.�lr ---------------------------- .............. City � �- ....................... Cantractor's Name .---- Li ease :........:: .:......�--Phnye ............................... Installation will serve: "Re) dehce Apartment;House J!fCommerciai ❑Trailer Courf ❑ Motel []Other ------------- Number ------- ---Number of living units:_.._.----- Number of bedrooms ..Garbage Grinder .......... Lot Size ----I.......... .. ... ...�__---__--.__-- Water Supply: PublicSystem and name .. ---------------------------------------------- eat Private [ � Character of soil to a depth of 3 feet: Sand Silt ! - p ❑ Clay ❑ eat❑ Sandy Loam-0 -.-Clay Loam ❑ t 1 Hardpan E) Adobe ❑ Fill Material ............ If yes,type ------------- --- ,---. . (Plot pian, showing size of lot, location ofsystem in relation to wells, buildings, etc. must be placed on. reverse side.) NEW INSTALLATION: (No septic tank or seepag"it�permitted if public sewer is available within 200 feet) PACKAGE TREATMENT, [ ] SEPTIC TANK Size.A_2,c<_.e _4/_ €_._...x Liquid Depth _._ ,..._„_:...... Capacity .cT ell Material No. Compartments -2, ... ' # . .. yp ! ...:.. f coo Distance to-nearest JNell1 ::'.. '' ....................Foundation .f........:... Prop. Line :......... d L!`ACHING L[NE [ } No. of Lines .....i.._. �. —:�-l:ength-of each line.-----©�---•--------. Total Length .....�/aft..... -` 'D' Box . ------ Type Filter Material r�.aL . ....Depth Filter Material .......11..............................n 3� f Distance to nearest: Well _,6_62... Foundation -A. .1.... Property Line�....:�:. � D v .. P 7 SEEPAGE PITT” Depth -.- -----, Diameter ................ Number ....-----.-......._.._..._.. Rock Filled , Yes ! ,No-C) Water Table Depth f' ......... _ �r•f , � --.......__.•.............••-•••-Rock Size ---.. -••• pro Line .� 2 r, I Distance to nearest: Well . ....................................Foundation p. .. ......--- = � REPAIR/ADDITION(Prey. Sanitation Permit 0 ..............= ...............•----------- Date ...... .---- --•----- Septic I { Tank•(Specify Requirements) ----------------------------\•......................................../............. --------•--- ----------------------- _.---•-•---------- Disposal Field .(Specify Requirements) ......................... ,...-----...-------------------`................................•---. ....---- ------- ... ........................ --••• ---------------- ................. .... ....................---- - ------ - • -- Ir .� ................................. ? " - ---------------- — --- --- — '` ...........---- '(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 f6ilowing!' , y "I certify that in the perfoi once of the work for which this permit is Issued, I shall not employ any person In such manner l as to becom vb;ect to W'orkn�n's C . o nsatibn laws of California," ' Signed ► r. `� f � Owner , i �...ff . By .. . ....................._.- _ .. ............ ........................... Title ...•-------------------.._._. ................................ (If other than owner) ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED'SY_..._. .........:�P....-. D%ATE ...... ._____•- - BUILDING PERMIT ISSUED=... ---- --------------••-;- --------------•---------------------- 4 . i ' � ........................... '•-:--...DATE ...:. ? ADDITIONAL COMMENTS.: .... - . ., � .. ...... ' �. t.. .. ....................�. - .-.F... .... i .. .. ._......... • • '..... _----•--- :. 7Fina! Inspa .:. .......................... Date _ SAN ....s.•. JO QUIN LOCAL HEALTH DISTRICT _ F w 1.3 241.'AA Rau r%AA 7/723-M