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FOR OFFICE USE: APPLICATION FQR-SANITATION PERMIT 7 3 C ------------------------------------------------ -- (Complete in Triplicate) Permit No. ------------------ __________ This Permit Expires T Year From Date Issued Date Issued i 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: a JOB ADDRESS/LOCATI ...1 .,...r !�?- _Lc; r aG. "- CENSUS TRACT -------------------------- ,,Q F, / /�`� =--------------------------- Phone ---- -- - ------ ---:----- Owner's Name . k Address ___ ` / � ---1— ---- ------ City !�'L�C +,C/. ✓-- -------------- Contractor's .__Contractor's Name .... ---------License Phonej Installation will serve: Residence XApartment House❑ Commercial ❑Trailer Court i❑ f Motel ❑ Other --- ------------------------- Number of living units:--/------ Number of bedrooms ------------Garbage Grinder ------------ Lot Size __ Q__. ------� - Water Supply: Public System and name -------------------------------------------------------------------------------------------------------.------Privatex 4 Character of soil to a depth of 3 feet: 'Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam:❑ Hardpan ❑ Adobex 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 seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK'f J Size------------------------------------------------ Liquid Depth ----------------........... A Capacity -------------------- Type -------------------- Material---------------------- No. Compartments ------_-------------- -r _j Distance -----_------- ---- Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ------__._:-.__-_._.._ LEACHING LINE [ ] No. of Lines -----J---------------- Length of ea h: line....... 2p-r..;_..... Total Length�r_-_.�_�._.�__---..._. 'D' Box .4--clIL Type Filter Material _ - ----Depth Filter Material ..---/Co....................... 1 ---1W r� ---10---r-�------ Property Line ------ ---•-- r Distance to nearest: Wel'I �_.----�- � i�mberon-.... ................ Rock Filled Yes No I❑S� -- SEEPAGE PIT [ ] Depth ..c�-=?� :. Diameter Z.— � t(15�� Water Table Depth --------_-�V-----------------------------Rock Size ---- �� Distance to nearest: Well .........................Foundation -.._.lQ---' Prop. Line .... .......... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date --------------------..------------) y Septic Tank (Specify Requirements) --------------- II or Dis sal Field {Specify Requirements) r ---------•----- 4 ' - '"- -'- ----- --- ----------------- --- '—.. rs_r; .1 -------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------- (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, I shall not employ any person in such manner as to become 00ict to Workman's Compensation laws of California." Signed ' ... ---------- Owner By ------------ - - - --------- --- �.��------- -=--- _ Title . .. (If other than owner FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- DATE ---- '13 BUILDING PERMIT ISSUED ---- --DATE ------------------------------------------ ADDITIONALCOMMENTS -=----------------------------------------------- ---------- ------------ ---- ----------------------------------------------=-----------•---•----------- ---------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------- ------ -� ------------------------- -------- ------------------------- :---- -- --------- Final Inspection by: ---_ - -- - ------ - -- Date -- --�� --��-'�--•- I SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M