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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -•.......... ..... -------- Permit No. ............. ..._:..._.•... ---- (Complete in Triplicate) ' � :.� .. ._._......I.___.__.. This Permit Expires 1 Year From Date issued 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/LOCATIO 1 . ��.��-.. ... ......... T .' , ri..� . �. a, .._ :^••." Owner's Name 7 > --• -- -- Phortie.. Address V:-i_: a.7. ?�. .........._...---._...._... :._._. City ... ' :............ s f Contractor's Name :- it-- -- - -' .L'ice s # � 0: + _ ;. Phone ,.... -- . �- n e' Installation will serve:` Residence [�Aparfinent House-❑-Commercial MTrailer Court.--O, Motel C]Other .,. .... _ J � ,� Garbage Grinder '_........... tot Size ..._.__....:_... ...:------:.. Wateb Suof I'v'PubIiCIS stem and n.amer of bedrooms .; ,_ J E PPY� Y ...n;.............Silt Cla- ---;----•-Peat............... Sand--•�---.----0- .......Private .. •• --._..... Character of soil to a depth of 3 feet: Sand 0, ❑ y` ❑ y oam Cla Loam E P ❑ ❑ al .... If:yes;type ... Hardpan Adobe Fill M'ateri (Plot pian, showing size of-lot, locatigr► of systerrt in�relation to..weils;,,hwldirigs, `etc..,.mutt be. placed on'reverse side;) QO NEW INSTALLATION. {Na septic tank or seepage,pit permitted if.poblic,sewer;is aua 1.able.within 200 feet,); PACKAGE TREATMENT { ] SEPTIC TANK j ] Size __...._ Liquid Depth ...:............._..._ ' Capacity ..:. Type. .. Material.--..... --------------- -. �No. Compartments Distance to nearest: ......_•- :Foundation .... -.-----.......%.._ Prop. Line. ------------ ----- - LEACHING LINE ( ] No. of Lines . ', .- Length of each line ..:..:....:.............',... Total Length ........... } De,pfh'Filter Material D' Boz :.:.: Type Filer Materia)' _- - i Distance-to nearest; Well -- Foundation _. ..::'-- _--' ? Pro er Line .. .._ ............ SEEPAGE PIT [ ] Depth ;. Diameter Number :; Rock Filled Yes ❑ No (� Water Table. Depth . =.......... ...... -------Rock Size . .................. . r Distance to nea rest: Well ,.Fo ►ndation- ,. .Prop Line ..................... -- I' Q .... - REPAIR/ADDITION{Prey. Sanitation Permit# . _--- ate -1 ;Septic Tank (Specify Requirements) .. . ............ =. .•-•--- ........................... --- --------••-•--•-----.-.,. •--•- -- •. -------------- Dis osal Field (Specify Requirements)' :......... ---------- . ----- {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 Reg`ulotions of the San Joaquin Local Health District. Home owner or Hcew 1 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 such manner as to become subject to Workman's Compensation laws of California." Signed- - ------------�-----.--- ---•-•--�-- - - O Ow � ,�•- �. BY - Tit (if other than owner) FOR DEPARTMENT USE ONLY i[j-. -_ DAT E . . .�.�.�`._...~...�C.............. .....:..._ .......DATE .-----------••.. ........................... APPLICATION ACCEPTED BY ....... ... .. .... .. BUILDING PERMIT ISSUED ...............-- . :_.�.::,. ---,. . ......_..___-. -'..:--..._.....-.----• iADDITIONAL COMMENTS ....... .---.-..............:.... .........•------- ------------.....-.--- .;.------ ---•.------ ......:. _.._................... ...._._....----- --------- ----- ................... ................... ............... .............................................................. •. ......... ............. •------ .--_..... _ ........ ..... ...... Final Inspection by: _.. .... - Date ..............._....... ... R SAN JOAQUIN LOCAL HEALTH -DISTRICT _ F_ 14_ 1-3 24 1-•bs Rev. 5M -_ 7/723 M