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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT •. .. ...................................... ;Complete in Triplicate} Permit No. t�� ...... ... . ...................................... This Permit Expires 1 Year Front Date Issued Date Issued Application is hereby made to the Son 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. 544 and existing Rules and Regulations: rn tr JOB ADDRESS/LOCATION .......�t�. ?a. ._,.. ?t.:... ..... ;F, ............. CENSUS TRACT .............. s . Owner's Name ....................:..r-4 - (.e1€f f+ ,...............:........:..:.........Phone ...............6.... Address City ..... Contractor's Name -----•--........_. �. `--- .( ..` L .-.4!_�,..License # ZX4�54��3... Phone .. 6.-?'6. Z - , Installation will serve: Residence d§Apartment House❑ Commercial ❑Trailer Court 0 Motel ❑Other Number of living units:-----/----- Number of bedr oms.,X.....Garbage,Grinder ............ Lot Size ................... Water Supply: Public System and name ........... .. '' '-------- .........._-................................. .........Private ❑ Character of soil to a depth of 3 feet: Sand El Silt❑ Clay ®-- Pea.t C] Sandy Loam "❑ Clay Loam Hardpan ❑ Adobe'@I-'Fill M6terial ............ 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: INo septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK,[ y } F Size................. ............................... Liquid Depth ..........................N f Capacity -- TYp® : Material Na. Compartments = ....>. 0 Distance to nearest: Well .....................................Foundation ...................... Prop. Line ------................5 LEACHING LINE [ ] No. of Lines ____________________ Length of each line--------------------.___._._. Total Length ........................... 7�- V 'D' Box ............ Type Filter Material ..........:.........Depth Filter Material ..................................., , Distance to nearest: Well ........................ Foundation _------------ Property Line ....................•-- .� SEEPAGE-PIT [ j Depth ._._..._.._...____ Diameter ................ Number ...._.._.._.__.__-__._...... Rock Filled Yes ❑ No { � � Water Table Depth ..........................Rock Size ----------:.:.................... l Distance to nearest: Well ........................................Foundat€on ......... !...... Prop. Line ................ t REPAIR/ADDITION IPrev. Sanitation Permit# ............................................. Dote .._.....---•----......._ . ... _] i Septic Tank (Specify Requirements) ................ .................................... ' �Disposal Field (Specify Requirements) ...........................�._ -"� _.__ __ ..._� _$._X_------- .....:.............. ----------=-----------•---------•--------------....._...-------------------------------------------- ..................................................... ----------------------•---------•----..................._..--------•------------------j------------------...................-................................................................. k} (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- K 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 become subject to Workman's Compensation laws of California." Signed ------------- _.._..._.. Owner By _..:................. ....„._ . . JtJ . Titley.,... _... 6................................ (If other than owner) FOR DER TMENT USE ONLY APPLICATION ACCEPTED BY .• __-. . ... . ..:.... .�..._ .._ ...................... DATE .... ........... ........... BUILDING PERMIT ISSUED .................. ................................. ADDITIONALCOMMENTS .......................................................:...........................................•----••-•----•------*........... i ........................................... ....................................... Final Inspection by. . ... :95 . ................. ....... ...........................:...Date _ ... . 3 SAN,JOAQUIN LOCAL HEALTH DISTRICT L F w 13 241_'Act oau RAA 7172341.4