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FOR OFFICE USE, , APPLICATION FOR SANITATION PERMIT tCPermit No. � .... ...f�....�...�...._. omplete In Triplicate) /a �_ ..... This Permit Expires I Year From Date Issued' + Date Issued ........ -1n. Application is hereby mai a to the San Joaquin Local Health District for a q permit to construct and install the work herein , described. This application is made in compliance with County Ordiriance No. 549 and'existing Rules and Regulations: :Ili r ,r JOS ADDRESS/LOCATIONf1.. ,.n-P.............CENSUS TRACT I Owner's Name _..-_. Jot..... . ............. .. ,. ..... ..............-............ . .... -..Z ..- ' ....Pone ' Cn .Address ... .....9City � ............ ... ` Contractor's Name .._._. ...:cr.. �/2�� 1...a . '.-.... %�Lr...License # ................ �—��0`� ._...... Phone - •---••--••- .. Installation will serve: Residence❑`Apartment House Commercial❑Trailer Court�❑ Y-•`• Motel ❑Other..4.Apile...Gas -A~ Number of living units:-.-'.-,,------ Number of bedrooms Garbage Grinder Lot Size f ® +� L� ..:........ ...... �.._...r.......•. Water Supply: Public System and name -----------------•------- . ...........Private, ••-•------�.... •-._.......Q............ ......---•-....... Character of soil to a depth of 3 feet: Q Sand❑ Silt❑ Clay Peat Sandy Loom Loam Clay Loam ❑ Hardpan Adobe o Fill Mater€aI ............ if yes,type j' (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (Na septic tank or seepage pit permitted If public sewer is available within 200 feet,) PACKAGE TREATMENT ( SEPTIC TAMC Size---••.--- -- ......_. Liquid Depth �r�... 9 + Capacity '�__. yp --(.��c. Materia ...__ No. Cam artments '_Q...._ . T e �-- p /0 Distance to nearest: Well ......, -. _D..............Foundation Prop. Line ..... ............ Founds#ion ........----•-.. LEACHING LINE No. of Lines "I4—Total .. ••-------------••-- Length of each ine�4...._7V. Len #h .... ......... tr 'dl Sox ..__. __--- Type Filter Material __. !2-t-ion Depth .Filter Material ...1.� ............ . � Distance to nearest: Well d.�......... Faun .. _ ..... Property ..� u SEEPAGE PIT [ 1 Depth Diameter ................ Number ..__..... Rock Filled Yes ❑ No ❑ Water Table Depth .................. _......Rock Size Distance to nearest: Well foundation . Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# .........----------------------------------- Date ------._ ......................... Septic Tank (Specify Requirements) ...............11! ..•---..-....----------...__......... ................................ .............. ....................... Disposal Field (Specify -'`Requirements) -------------------.•...... ......................._ ----------- ------------------- ..............._.................---............ •- �! •--------------- -..--------------------------.... --- -------••--••......................................... - - • - ------------- ---- ----- -- •-- ------ • -•_. {Draw exi st i ng 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, Stale Daws, and Rules and Regulations of the Saar Joaquin Local Health.Dlstrlcf. Home owner or Iicen- sed agents signature certifi s the following: "I certify that in the perfor"ionce of the work for'which this permit is issued, 1 shall not employ any person In such manner as.to beco subject orkman's Compensation laws of California.,, : Signed By --•------------------------ ---- II!' le Ti7 ---- (if other than ow`��ner) a ` ��. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B ___ - f 1 E � DATE PERMIT ISSUED -------------------------------- ------------------ DATE .-U ----_-- - ...ADDITIO C ENTc�.- -- --- - -------------------- - ..._._....------ -- ----------- ------------------------------------------- ---------- - - - -- - Final Inspection by: ------------!I........... ..'_-,'_ Date . Eli 13 24 1-613 Rev. �5� ��. ...�' SANV UiN LOCAL HEALTH DISTRICT 8/7h 3M t