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FOR OFFICE USE: eAPPLICATION FOR SANITATION PERMIT �......................... .. -- (Complete in Triplicate) Permit No. ..7 =.._!x'63 ..................................... ................ This Permit Expires 'I Year From Date Issued 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 m de in compliance with County Ordinance Na, 549 and existing Rules and Regulations: ` JOS ADDRESS/LOC TION d.tr .. ....CENSUS TRACT .......................... Owner's Name .. :-.. ......................... -_----.........._, ...................Phone. , ..��-. Address .-..--.-... ,� �. . E�... . f�� City ............................................. Contractor's Name -- •-- -- -- License # /�"d�... Phone ,C�J' ` Installation will serve: Residence;kApartment House❑ Commercial ❑Traller Court a g f _ ❑ Number of living units:.--.. Number of be rooms _. ... Mote Other -. _...... I ......• _...Garbage Grinder ..-"'1':�"tot Size .��`-:�C.��O_ ! l Water Supply: Public System and name ...... -- ..........._....................................................Private ❑ Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam [] � Hardpan ❑ Adobe Fill Material If yes,type ........................... i (Plot plan,,P 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 Apjt permuted if.public sewer is available within 200 feet,) PACKAGE TREATMENT [ SEPTIC TANK f ]�Eki.rr ;Wilc r Liquid Depth ................ .:........ Capacity -----------------_- Type ............. Material----------....-:------ No. Compartments .... .............. Distance to nearest: Well ------------------------------""'Foundation ...................... Prop. Line ................. , 1 t LEACHING LINE No. of Lines ..-..- ------------- Length of ach lie.--. -.-f..-.---._. Total Length _010:.0............. c y' V Box .._/---. Type Filter Material . .. . ......Depth Filter Material _.., ..........................:... Ir Distance to nearest: Well _..._ Foundation ` ................ Property Line ................. to 1 SEEPAGE PIT Depth -enc. .!_.. Diame er Number ----_-Z............... Rock Filled Yes 2t No ❑ . .. ...... . Water Table Depth .�s ...Rock Size r•�� ``� r Distance to nearest: Well Jt'&............... .._Foundation -__ Prop. Line : .__._............ REPAIR/ADDITION(Prev, Sanitation Permit�# ....-_... } � ..---.._..--••-•----•-------------- Date -•---•-•--.......-•---------••---- r Septic Tank (Specify Requirements) _----------------- i Disposal Field (Specify Requirements) ... . ......... „� I ------------- zg.• ...... --Y- --------- •--------- ............ -----------------------------------------------------------------------------------------------------.---- •----------..--.------------------------------------••-----------------......... (Draw existing and required addition on reverse side) j 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 Following: - "I certify that in the performance of the worn far 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." Signed ..... Owner BY ..•'�G Title ....--. :. (If other than owner) FOR DEPART NT USE ONLY APPLICATION ACCEPTED 8Y .... :. `. �,.... QATI: ... _..: BUILDING PERMIT ISSUED ......DATE-------------.--.---- ..................................... ADDITIONAL COMMENTS . �� :::::.. 1 ---------------•..................:--_.--•._.............--•.. mac• .,�. -•----•-•-•----•----=----------- --•-------------._..---..------------...........---- .......----•-.... ................................. •....I....... ............. ..... •. :...... ...`...----•---•---- ---•----•-•--- --------It ;. Final Inspection by: -._ Date ...._ .. . - SAN JOAQUIN LOCAL HEALTH DISTRICT L�H.13 24 1.'68 Rev- 5M 7/72 3 M