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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. z �C (complete In Tripllcatel ... . .................Alto............._...... This PernrnitExplre's ]Year From Dati'lssued Date issued ._. ` .._.:=.7 Application is hereby made to the San Joaquin Local Healt.h District for a permit to-construct and Install the work herein described. This application Is made In complian- ith,County Ordinance No. 549 and existing Rules and Regulations �J� y ? t JOB ADDRESS/ OCATIO ,:- -•-•--._._.`'``u`'4-LJ_ .;............:..... . -- ... ... ... .....CENSUS TRACT ..... Owner's Nome ......... .. _.. / Phone �7.... 44 . ....... ..................................-t City -•-�----�.4 ... .. .................. --••--•--••- •--- Address 7 .T_._.�..../'....._..._ , ...-. -..... Contractor's Name ---- __-.- `~ { ""s License # .................. Phone ...................x..... __... Installation will serve: ResidenceEr;Kpartment House 0 Commercial pTrail.er Court 0 Molt[]Other ---------------- ................... .................. 'Number of living units..-/..-..- Number of bedrooms ....Z-..Garbage Grinder _._._:..__.- Lot Size ./ Water Supply: Public System and name ........._!,t.��....-•...........=----------------.......... Private 0 Character of soil to a depth of 3 feet:_...Sand,EJ--Silt[j••---TClay.[3,• Peat❑ Sandy Loam 0 Clay Loam ❑ fi 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.) I� NEW:INSTALLATION: (No septic tank or seepage pit permitted If .public sewer.is available within 200 feet,) I PACKAGE TREATMENT { ] SEPTIC TANK{ ). Size......:................ ......------ Liquid Depth ............:............. I Capacity -------------------- Type .--- ....... Material 't................ No. Compartments ...................... Distance to nearest: Well- .---- ---- !... !Foundation ... Prop. Line ..................... LEACHING LINE [ ) NbL.. of Lines ------------------------ Length of each/line........._..__._..-- Total Length _.-_...._._......-._......_. Jr 'D' Box ------------ Type Filter Material -- --- ........Depth Filter Material ............................................ 'J l Distance to nearest: Well -------•..._......_./... oundat!on ................ ...... Property Line ..........._ ............ v' SEEPAGE [ ) Depth .................... Diameter ... ...... mber .........._._...:._. ...... Rock Filled Yes ® No i 1 # Cb7 Water Table Depth .................J(---....•--........:--- ----Rock Size _..._.... .................. 'f I Di�tance to nearest: Well ..._Z....:........... ....... Foundation .._.___.__..._...._. Prop. Line ....................... - REPAIR/ADDITION IPrev. Sanitation Permit# -•-�•............................�...... D e ......................I.......... .} � SepticTank {Specify Requirements) ......__.................•__......--•-...............-•------_.:•.-_...................•---------........._........._.......... ........... t -- ---------•----•----- � Disposal Field {Specify I Requirements). ------------------ --- -----------------#-•-•----•---------.......---•--- ........---- ---- ------- "( F • � , (Draw existing Ad required addition on rever sidei 1 hereby certify that 1 have prepared this application and that the work will be done In accordance. with San Joaquin County Ordinances, State`taws, and Rules and Regulations of the San Joaquin Local Health District. Home owner-or licen• sed agents signature certifies the following: I "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 bece subject to Workcinan's Co p otion laws of-COlif rno ia." Signed C3. .- --------------------------------------- Owner By -•------------------•------------- -------------.--------------------- -------------- Title . _� r (If other than owner) , FOR DEPART ENT USE ONLY APP.LICATiON ACCEPTED BY .._ . ................... DATE..--_--- .._.._cZr_`_ Z 15... � BUILDING PERMIT ISSUED ... •. ........-•........................................................ DATE ? ADDITIONAL COMMENTS I-- � �E` -40,: . ------------�' --- ------ ---------------------- - --------- - ..................... - --.-... ..-...._... -- ------ -- - � ..-- ::::---:_ :::..._..._ - - ---- Final Inspection by- ------------- ------------•--• •-- .............. ---...._...--•- ----._._........Date ._.... ................................ ----------........_._._...._._. iR 13 2h 1-68 Rev. 5M SAN JOAQUIN LOCAL, HEALTH DISTRICT 8/7h 3M