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5-r(0 A10� FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �..................... ......... , Permit No. �..I (Complete in Triplicate .................................................... Date issued 3 .. .................... This Permit Expires 1 Year from Date Issued Applicationis 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: STJOB ADDRESS/LOCATION .....'l�3.11_ _ •��T/�� '�� :..................................CENsus TRAcr ._....__..._.....--------- Q A^� -4.1 a......� H ----•--•............................ ...................Phone '7 . Owner's Name .. � �� Address ��1.�.�..-........................................---------------•---••--. City ...._..�T4.. . _ ..�Q�----...........-_...----....__... Contractor's Name ........��C'L�-..f..._ �f -- License #�.7_� - ._ Phonef��.. a... :...... Instailation will serve: Residence Ca Apartment House❑ Commercial ❑Trailer Court 0 Motel ❑Other ----------_----_--_- ------------------ Number of living units*... Number of bedrooms _,...__Garbage Grinder W.0-- Lot Size L ----•- Water Supply. Public System and name --------------------------------------------------------- Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 0 Hardpan ❑ Adobe Fill Material --- ........ If yes, type -- ...............• (Plo�n, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.)1 NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK ] Size.............•-------- •----• .............. Liquid Depth .......................... Capacity Material ___._... No. Compartments ..................... •---.... - --•-••--- Type --•----------------- ---..._..-•--- Distance to nearest: Well ....................................Foundation ...................... Prop. line __.. ................. LEACHING LINE [ ] No. of Lines -----------------------• Length of each line-------------.----:......... Total Length ............................ D' Box Type Filter Material ...Depth Filter Material ........................................:... Distance to nearest: Well ..................... Foundation _-_._-----........__-... Property Line --•............... .. SEEPAGE: PIT [ ) 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) ............................... ............................ ................ ----:..-- ------------- T_....._ ... Disposal Field (Specify Requirements) .......... 2------------J-3--• X-air......��'� �l'�'�....................... - -----•--•- ------------._....--.............. (Draw existing-and required addition on reverse side) I hereby, certify that l 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. Horne owner or licen- sed agents signature certifies the following: I 1� - "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 .___ _ . Title -._E� /- -.�._ ... o � (if other than ow FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ............................ - ...._ DATE .. . ......... BUILDING PERMIT ISSUED ...............-..................----------•-----_. _......... .......... ......... DATE _..__........ ..._...._._.._......._..__. ADDITIONALCOMMENTS ..........................•-•-• .......................----•...._.............._........------.......__..... .... ............................•--•---------.........._........................................... ..............................................................••--.._............................. ---.............. ---..._.---....._....-•---•-- •-------•---....•. ........................................I..... -•---•-- ..-------••--------- - .------ ... _.. ................... ------------.._.......---- • .... ' Final Inspection by: ................. .....Date ...3.d �� --�.._.....---- SAN JOAQUIN LOCAL HEALTH. DISTRICT • Y r w 3.3 241-'68 Rev. 5M -- 7/723114