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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 4ICompfew in Triplicate) Perms W. : Date Issued 2:`� s ........ This Permit Expires i Year fresh Dow Ismool ._.... - Application is hereby made to the San Joaquin local Health District for a permit to constrict and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulotlonu JOB ADDRESS/LOCATION ... 5 _,.. c........14 rep_0--c ...CEP" TRACT ......................... o.d_. i h AZ 6 3- Owner's Name ... - • F/e �✓. ........._.5...:.... • ................... ....... ".....Phone .'? ._....-.......... ��... Address ... ........ ...._. ......... .....................City ... ...........•........---...................................... Contractor's Name ........... . .�'�!- License# ........................ Phone ._....:. ...... -....... Installation will serve: Residence❑Apartment House 0 Commercial❑Traller Court ❑ Motel❑Other.......................l �C A/7 Z_ 7 Number of living units:-........... Number of bedrooms ............Garbage Grim ............ Lot Size ................................ Water Supply: Public System and name . G-fiG/,,,----..:.-•-.-..•--.---------_-.-. ...............•..........................•...Priva e 0 Character of soil to a depth of 3 feet: Sand'[3 Slit❑ Clay Peat Loam CI Loam ❑ ❑ Sandy ❑ Clay ❑ Hardpan 0 Adobe❑ Fill Material ............If yes,type............... ............ (Plot plan, showing size of lot, location of system in rotation to wells, buildings, etc. must be placed on rewrso side.) NEW iNSTALLATiONs (No septic tank or seepage pit permitted If public sewer is available within 240 feet,) PACKAGE TREATMENT t l SEPTIC TANK I J Size.................. . ......................... Liquid Depth .............. ... Capacity .................... Type --•---•------------- Material...................... No. Compartments ...................... Distance to nearest: Well ....................... ....... .Foundation ...................... Prop. Lime...........:........ LEACHING LiNE [ J 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 GE PIT [ J Depth -------------------- Diameter ................ Number ............................ Rock Filled Yes ❑ No Q Water Table Depth ................................................Rock Size ................................ Distance to nearest: Well ........................................Foundation .................... Prop. Lim ......... ......... REPAIR/ADDITION(Prov. Sanitation Permit# ............................................ Do" .................................. Septic Tank (Specify Requirements) ......... Disposal - ... Disposal Field {Specify Require entsl --•- ... -•• -- .......... .... .. .._. ....._...5` .._.. ......G .".::... ............./'*"*** ........... ,........................ ............. ........... ........................ ----------•-- ................ ..........................-............................................................................................ (Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this application and that the work wiN be done M accordance with San Joaquin County Ordinances, State Laws, and Rules and Reguietions of the Son Joaquin Local Heath Dlstriet. Noose owner or Nan- 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 swch mama as to becomes ject to orkm�n's Cam ,an taws of California." Signed-- -- •. .... � . --- Owner By ..... -�. .... �. ...... Title ---------------- ------------ --•------.....-.........----------------- (if other than owner) 0156RTMENT USPONLY, APPLICATION ACCEPTED BY ---- ... DATE .. ...`.7 �...: BUILDINGPERMIT ISSUED ... ..---•....................................•- . ..................DATE ...................................... ADDITIONAL COMMENTS .................... .............................................. --- -- ---- -- . ...................... .... ..••-----.........-....._........... ..............................._.....--•- --•-• ---- ............................................. Final Inspection by: .-..-.. --: ....------••-------------•-- . ......................................................................................Date .._.. --------.......•----- ............... EH 13 2h 2-68 Rev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M