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FOROFFICE USE: APPLICATION FOR SANITATION PERMIT tComplete In Triplicate) Permit No:..................... _........a..................................•-----•-•- Date !sued /p2-d•'_-7�" .. This Permit Expires f 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 Regulations: JOB ADDRESS/LOCATION .._..- .. .. '� .r+G :.... I � . ... %!"" CENSUS TRACT .. �R Owner's Name ..............•.............................._.--....Phone ,. Address .------- . ............... ........••---•CItY ........... ..,........---- Contractor's Name ---------------4* !p rr---------- .......................'...............License# -.. •.......... Phone .............................. Installation will serve: ResidenceApartment House Commercial❑Trailer Court ❑ Motet ❑Other............................................ f / Number of living units:.... Number of bedrooms _...Garbage Grinder ............ Lot Size ..��_..x./..��.__.•_.-.__-_. Water Supply: Public System and name ..Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay 0 Peat❑ Sandy Loam Pr Clay Loam❑ Hardpan ❑ Adobe 0 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 permltted1f ublic sewer is t tailabl within 200 feet,) /A�cfa f `� 00 PACKAGE TREATMENT [ ] 'SEPTIC TAMC{ ] Size.......................... �C- Liquid Depth .................... T Capacity_ ---- Type --- ----------------ateriat ? .:. No. Compartments ----•- -- _0 Distance to nearest: Well ___ ------................Foundatiorg -_-_.`,�'�--..__-- Prop. Line _._.T_ .......... LEACHING LINE [ ] No. of Lines Length of ch lin .._.-.-- Total Length ..Z�e.f �...................�] 'D' Box ... ------- Type Filter Ma erialk��..... opt Filter Material .__-..f,�...................... Distance to nearest: Well .... ..... Foundation ....1P Property Line .....Ir............. SEEPAGE PIT [ ] Depth ------_-----------__ Diameter Number ............................ Rock Filled Yestr No C]E Water Table Depth -----• ................ -------------------------Rock Size ...........----- ............... Distance to nearest: Well ..... .................................foundation .................... Prop. Line ....................... REPAIR/ADDITION(Prev. Sanitation Permit# ------------------ ......................... Date .............................-__-.) SepticTank (Specify Requirements)----------- ........--•................................................................................................................. Disposal Field (Specify Requirements) -------•----•-----•.................•----•-----"-`---•--......----.....----•------------------•--......------......................--- ------------------ ------------------------------------------------ -------------------------------•........_........---.................. ..................................................... (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 certifieswing: "t certify that in th dorm ce of t e w rk f r which this permit is Issued, l shall not employ any person in such manner as to bec e s b to Work n's mp ns ion laws of California." Signed ........ Owner Owner --------------- -•---- --- BY ------------------------------- -------------------------............ - Title --------------- ---._._._.._... -..-- . _ . _ (If other than owner} FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . ' ----- - DATE .._ ._ . BUILDING PERMIT ISSUED -------------- ------------ --------......................._..-.---------------------------------DATE ---------------•---------------------- ADDITIONAL COMMENTS ----------------------.............................. = ----------•----------------- ...._.....-----. --------------- ----------- •-------1�----------------.-. - - - ---•-•-- ...... Final Inspection by: ... -------- ---------------Date . ./(� C�....-•.................. EH 13 2h 1-613 Rev. 5m SAN JOAQUIN LOCAL HEAL 1STRICT 8/74 3M