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1, FOR OFFICE USE: J APPLICATION FOR SANITATION PERMIT Q -------- Permit No: .:. 2.� ' (Complete-in Triplicate) .................... - 7 ..................................................... This Permit Expires 1 Year From Date Issued bate Issued .................... Health District for a per to construct and install the work herein Application is hereby made to the San Joaquin Local Hea p e o Ic ere described. This application is made in compliance with'County Ordinance rNo:549 and existing Rules and Regulations: E JOB ADDRESS/LOCATI �N ,.....•_. J� ....- ......_..... .CENSUS TRACT .................:x.: Owner's Named - x ......................... ..---. Address ............... . .............. _ r� ....._.... City _..... 1 P- . ..} Contractor's Name _'..'F e_A....__`.__�...... . ........•--._......-.........................License # Phone . Installation will serve: Residence [] Apartment House Commercial:❑Trailer Court 0 1 •� � . f ..Motel ❑Other ............... ==---=•--•-•-•- _.._..... a Number of living units:----- Number of bedroomss _.. .. _Garibag rinder�._.._�_�`Lot Size . ° ..F... . : r . � , Water Supply: Public System and name --•,-......._.. '-•..................................... ...................-......._.-_-:.............,_..Private ❑ i Character of soll to a depth of 3 feet: Sand - Silt❑ :Clay 0 ' Peat❑ Sandy loam ❑ Clay Loam E]--�- .a- .-� f Hardpan ❑ Adobe ❑ Fill 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 TANK . . [ I '"` ` ;Size.................""`-------- -- Liquid Depth Capacity ......Type " jM aterial-... .... No. Compartments _._ ......... d.• ' Distance to nearest- Well �... .................. e - -•--.......Foundation ....__...--•-----•---_ Prop. Line �'-�-----------'-: LEACHING LINE [ ]. No. of Limes __-__�_.____ _--_•80f_ength of each line--- Total length ..Frr 'D' Box ....f...... Type Filter Material .. ...Depth Filter Material -------------- ----------------:.:.:..._:.. 'Distance to nearest-lM17eil' :._ "T Fouicl6t'ion Property Line _:�Fr_`__.:.__::------ SEEPAGE PIT PIT De th . Rock Filled Yes � .•. Na }� [ 1 p -------------------- Diameter �:•--------•--... Dumber ...._.:.............._.._ . ❑ 0..,:. , Water Table Depth ------------------- \---•-----..............Rock Size ................_-_. .......... r. Distance to nearest: Well _________________::_;..................Foundation.___---_----.-__-.__ Prop. Line ---- ...... rti e REPAIR/ADDITION(Prev. Sanitation Permit# .................................... r• •_. 'Date _ _ = /) — -------- 1".._ - .------------Se tic Tank (Specify Requirements) -- : .��- 1 - _Disposal Field (Specify Requirements( . - ............. .. ...... .......... ...... ..................`_.... .___ ...... ... ._ _ . ------------------------------------------_------------------------------------------- _. .. (Draw existing and required addition on reverse side) ` 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 licen- sed agents signature.certifies the following: f "Icertify 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 I ws ofCidfornla." Signed ....... ! _ 1�! >Y ��d •--•-- ......................... Owner - By ......... w - ..._ ....-.....--•-- -•---• ---•-• ' 'Title d......... .................... -- -•- (If other MR DEPARTMENT USE ONLY 4 i APPLICATION ACCEPTED BY ... _. ... .. DATE ...._. _` _.—.72_.......... BUILDING PERMIT ISSUED ................... ........................- •....... ........ --•_-.......................---........ . . .. . ADDITIONALCOMMENTS ............................................................ ...........................................................-- .....:. ................----------------------------- -----•..._.................................. _ ..........:...._........ •. .._. ...................•-...••---- L ri7 Final Inspe b p Y = ate .. .................................. SAN JOAQUIN -LOCAL HEALTH DISTRICT F u 13 24 z.-aa Qev 9AA 7/72 3-M