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FOR OFFICE USE: i S ✓ APPLICATION FOR SANITATION PERMIT i Permit {Complete in Triplicate) ..................:..._.... ........I..--•---•. _ n This Permit Expires I Year from Date Issued Date Issued Ac7.:c �3: r 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 Regulationss JOB ADDRESS/LOCATION .....-.� .1_ !� ...!v.......kf�L _�'t�...................CENSUS TRACT .......................... Owner's Name ---------b.�V.I--I------•}l=!`,L. X............... I.................._•---.... ....... ..... :.......... ......Phone Address ............. ............................ ............. ........................-................... City ..-........................-...._.......................... .......... ....... Contractor's Name ....�� ---------'�✓ Phone ......:....................... .._....... ....__ ..--•-----.......License # ..:................. Installation will serve: Residence 0 Apartment Housea Commercial OTrailer Court u Motel ❑Other............................................ '�Z i Number of Living units:_.__.._ Number of bedrooms .........Garbage Grinder ............ Lot Size ........................ ..... Water Supply: Public System and name ......... ••......................._........... - .......................:...............Private ❑ a Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay N' Peat❑ Sandy Loom ❑ Clay Loam ❑ Hardpaq Adobe❑-Fill.Material............. if yes,type..�Q. -- (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 j ] SEPTIC ] Size........t........... ......E_...�....... Liquid Depth ......................... Capacity ._f. o_..________-.... Type ---.R tenial.._ 'RRr� o. Compartments Distance. to nearest: Well :... 1�..• _..... ... Prop. Line -.................. LEACHING LINE Al No. 'of tines ...... ---_--..-__- Length of each line �� 9 ............... Total Length ............................ 'DBox ..../_..... Type Filter filter Material ._. ..r...............................Ti SUS Distance to nfures II .:.... ........•--.-_-.. Foundation Property Line ....................... -4 SEEPAGE-Pt'f [ I Depth Io r ................ Number ............................ Rock Filled Yes ❑ No ❑ Water Table Depth ................................................Rock Size -.............................. Distance to nearest: Well ------------------------ ---------------foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prey-."Sanitation Permit r# .........................................•-- Date ............. .................... Septic Tank (Specify Requirements) .... ..... .......................................................................................... Disposal Field (Specify Requirements) -------------------......�11•-•---............ �:�5�?�,f'�'...-...................... --.------------------------------- - ----------•------ •........................_.__....---•--•-----------------...................----------•--------------•-•----•----•--• (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,Distrid. Hama owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, i shall not employ any person in such manner as to becom jest o o n's Compensation laws of Calif nio." Signed ------- -------------- - - - • ---- -- Owner By ......., -------------------------------------------------- Tit.e If other than owner) FOft DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . -- . ----- . ... ----- ---- ------- ---------------- DATE .. BUILDING PERMIT ISSUED _.. ------------------ --------------------- _-- ---....DATE ..... ------------------------------------- ADDITIONAL COMMENTS ----•--------•----------------------------------•• - -------------------- ---------- --•-•-----------------••-------...---•-----• ---------------- -----•..__..._..---------------........._.._..----....--------- ---------- ------------•----._......_.... ---• - Final Inspection by: ....... . ....... ----•- -- -- -----------•----------------------------- ...........-...............Date -/�}--3 � ------------------ EH -------- -_.._ E i 13 2h 1-68 Rev. 5H SAN OAQUIN LOCAL HEALTH DISTRICT 8/711 3M � I