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FOR OFFICE USE: APPLICATION F6R SANITATION PERMITxr� � 7 . .I .. . ....... .......... Permit No. ............F.._.._.. (Complete in Triplicate) ........................................ Date Issued ..............:.:... This Permit Expires ] Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per to Construct and install the work herein described�hjppli a on ism e ' 1i c 'th.County Ordinance No. 549 and existing Rules and Regulations: P9 ........CENSUS TRACT ...... ........ . 108 ADDRESS/LOC TIO �" �a..'...... tt .. _. . .. .rc�l !•• - - !d//�1. ��. � „. . .........Phone . ...---•--•..................... .� Owners Name �.n►...._. Address __. — i �1�`'`-----•----•-•--. City . ..................... .................. .......... ... ... License #o��l, ...-. Phone .. Contractor's Name IA �._ Installation will serve: Residence partment House f�-Commercial ❑Trailer Court Motel ❑Other.._._........: .............................. Number of living units Y7 Number of.bedrooms ..___ .Garbage Grinder ..-. Lot Water Supply: Public System and name ._.....- .........................Private C3 Character of soil to a depth of 3 feet: Sand''❑ Silt❑ Cloy ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ill Materialy""-- if yes,type .••---•---•-------------- (Plot plan, showing size of-lot, location of. system-in relation to well s,rbuildings,.etc.--must-be:placed on reverse side.) NEW INSTALLATION: _(No septic tank or seepage.pit permitted if public sewer is available within 200 feet,) j U PACKAGE TREATMENT ( I SEPTIC TANK Size ' .. ........... Liquid Depth �`Z- .. Materia No. Compartments .._ ?7n............ Capacity ._��..---..... --. TYp _ ....- ---- -- Distance to nearest: Well �•.... Foundation _f_ •. ----...... Pop. Line . �......------ -- Prop LEACHING LINE No. of Lines r`�------ Length of ach line.__��--�� Total Length /. .....�------ .�- - __.� ._ _. _. r. -. - D' Box Type Filter Material ..•Depth Filter Nlatenal { .................. ............:... pistanc to nearest: Well ..,5V.1........... � �r .... Foundation J`?�-------------• Property Line .. ..---•1- De Depth Diameter f/�1 ..... Number ----••- ............ -. Rock Filled Yes M qb Q IT [ } p ............. www *��y.y rr �k r.,.� Water Table Depth ._ /_..a�..y ..................Rock Size __f_.lZ� --••-• -•-• ._... r i Distance to nearest: Well , ..5'� Foundation ..,,�. .:........_ Prop. Line-------------••---.. REPAIR/ADDITION(Prev. Sanitation Permit ....... Date ........... , ............ ............ Septic Tank (Specify Requirements) .................................................................. ........................ ..........= - . Disposal Field (Specify Requirements) --------- ....................... ............................... ........................ Esc {Draw.existing and required addition on reverse side} r I hereby certify that t 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 Mold. Home owner or licen- sed agents signature certifies the following: • "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner € as to become subject to Workman's Compensation laws of California." li Signed = Owner ................. . Title ..:. (If other t owner) F R DEPARTM USE ONLY 7jcJ DATE APPLICATION ACCEPTED B "• .. .. 7.... _ f BUILDING PERMIT ISSUED ' •--••-. ....... :.. . r� ..."- •• • . . •---- .. •-• . ... � .-•-•- ADDITIONAL COMMENTS ...5 /.. - - _ :¢ .... ....... ...•-- ............... ...... -- ............. -------------------------------- - --- - ----••--•----...... .Date - Final Inspection b ........ ...................I /s �. . _ JOAQUIN. LOCA L..HEALTH t)15TRi W. • SAN.. 7172 3 14 11 24