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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ..7� .. .. (Complete in Triplicate) ................... 7 .�... p Dote Issued This Permit Expires 1 Year From Date Issued 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 Regulations. `� ._.........CENSUS TRACT .......................... JOB ADDRESS/LOCATION ..!` •:! a� --• ` �✓,.. ..-_....... Owner's Name :.,,� f->f. .............................. ......... Phone ......... ... _ Address _....f ......_ .......... City Vii! .. - . . .. `'• Contractor's Namex.... ..A%. A..............................�` � License # ./. - Phone .............................. Installation will serve: Reside ce �partment House C❑ Commercial❑Trailer Court ❑ Motel ❑Other ---- ••-•••...-••-••••g•-••-••......... Number of living units:..--.�_-_. Number of bedrooms ..I/.......Garbs a Grinder ............ Lot Size ....7.s.......................... Water Supply: Public System and name ..............................................................................................................Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan Adobe Fill Material ............ 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: (No septic tank or see ge pit permitted if public sewer is available within 200 feet,) P �� PACKAGE TREATMENT [ ] SEPTI( Size... .�.rl .. '.�-.-il`-.��7 -.2-•--- Liquid Depth .. ....................... Capacity Lfao...... Type ..... Material.-g-,e..._. ... No. Compartments ,P1 ............... - i Distance to nearest: Well -::SPL --- ----------Foundation//......Ie........... Prop. Line .. �'...............s LEACHING LINE [P No. of Lines ........: ..........._ Length of each line........3 5,�:r....... Total Length 'D' Box Type Filter Material 4L.9. Depth Filter Material ........ ................•-••••......•-�1 Distance to nearest: Well 5�' . Foundation 14'................. Property Line .. .... •.-•:.•••-•• ((j SEEPAGE PIT � Depth ...= .-�'. Diameter . •��-- Number ............. .......... Rock Filled Yes No Q Water Table Depth /. '. ...................Rock Size 1. ..• •-----•- J� ......... Distance to nearest: Well Q�" �•••-•-••••Foundation . ....... Prop. Line .. ............... REPAIR/ADDITION(Prev. Sanitation Permit# .............. Date .................................. 9 Septic Tank (Specify Requirements) ..................... '. ...........................-.�.................................................................................. o Dispos I FieI (Specify Requirements) ._� �� y� � �`'" .....'� - ..............•....-••--....._......._.... 3 .re- •-•-....-•---...--••-------------•-•----`•-----•-•--•--•-----------•-•-------........................... ---... .� :.-••-••......•-•••••.......... . (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- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become sub[e o Workman's Compensation laws of California." Signed ---- ---•----------• .... ..` ... . ....... ........._...... Owner Title ...�-e-J-4-da......4 �!..... By ---- --. .......-- ...... ............ ... . , (If of er than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ...................... DATE ....�.3D .7J.�- BWLDING PERMIT ISSUED .. ................. ........ .. ............. ,.. ...._DATE . _. ADDITIONAL COMMENTS ..< ,W. . �••-• �-'� .......................................................... AAe-. •••• --O:::....._.._..... :` ° .....__ .... ............. .-..----- ------ Final Inspection b �-�:.................:::..._..........�.•-'......,.. ................... ...................Date ..a�..G�..7&.. SAN JOAQUIN LOCAL HEALTH DISTRICT Gj �.s E. H.13 241-'68 Rev. 5M 7/72 3 M