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FOR OFFICE USE: _ ..........:.... APPLICATION FOR SANITATION PERMIT 7 ..:.. ..--- (Complete in Tdplicahl Permit No. ...`.. !' ........ ... 1 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 mode in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ... .._��ti7._. ...................CENSUS TRA ......... ................ Owner's Name ....../3e-49 -----./.ir,/.e.4f4Z.................................•--.....•............................Phone . ..0 `. r7e2... Address z---._ .. _.. _ ............ .............................................. City .......... SrT,I `Tt..... ..- Contractor's Name ..� ��.......�.,� ��.�� _...license#/.7J.X; .. Phone Installation will serve: Residence fq Apartment House t Commercial QTroller Court 0 MotelQ Other----•.........................•••........... Number of living units:...-1..... Number of bedrooms ...a2---Garbage Grinder &0... Lot Size .. ?G'.J............: Water Supply: Public System and name ........................................................_....................................................Private❑ Character of soil to a depth of 3 feet: Sand 0 Silt Q Clay ❑ Peat 0 Sandy loom[3 Clay Loam ❑ Hardpan 0 Adobe 14 Fill Materlal ............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 seepage pit permitted If public sewer is available within 240 feet,( .1 _ PACKAGE TREATMENT f ) SEPTIC T NKP Size...... � ..1!3' �• -----.--... Liquid Depth ...,�rY,z�.I........... `h ..... TYPO T CaPtY ype .................... Material 4X4047—No. Compartments .. ............- c Distance to nearest: Well ___.. ,r .......................Foundation .....1.C?......... Prop. line .... ......... LEACHING LINE No. of Lines ......./---------_-•.__ Length of each line......4,YQ........... Total Length �. ............. 'D' Box A0 Type Filter Material � ' /<...Depth Filter Material ./Ip................................... 1Q r r Distance to nearest: Well `-'=".. ... ........... Foundation ... .. ............... Property Line ............ SEEPAGE PIT Q Depth .... _ ..... Diameter ._ u..... Number ............................ Rock Filled Yes a No 0 ./_ Water Table Depth ......��Q..............................Rock Size .. ...:/r..,(._........--- Distance to nearest: Well ... .......................Foundation ....... Prop. line .... . ^........ REPAIR/ADDITION(Prov. Sanitation Permit# ............................................ Date ..................................) Septic Tank (Specify Requirements) --.............................................................................................._......... ..............---------- S ........... Disposal Field p (Specify Requirements) •_-------•.....................................•-•-----•--•---•-•---...-•----•------•---_----•.--•---...-•-------.........----.._.... ------------------- -------------- -------............................................................................................................................................ ----- ------••------------------------------------------•---------------------------- ............-................................................... ........................................ (Draw existing and required addition on reverse side) 1 hereby certify that 1 have prepared this application and that the work will be done In accordance with Son 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, i shelf not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ----------------------------------- --- Owner BY ----- .....-- title (If other t owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY BUILDING PERMIT ISSUED ._.-- DATE ��. ��. .��-.- ----.-- .................. •-----.....__......._.DATE ..................--............... ADDITIONAL COMMENTS ------•--•........................................... ........... ................................. ............................................ ................................. � ------.... -----. ........... .....----•....-..----- - .............. •---- Final Inspection by: .._ _ . .............................. to .--------- ........ ............................•--...... .. ..R. . :.........._...... FSI J.3 24 1`68 w• 5K SAN JOAQUIN LOCA! HEALTH DISTRICT $`?�! 3M