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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT I Permit No. ...7��Q/.o (Complete in Triplicate) ----..-- ............... 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 a e in mpliarncce with County nOrdinance No. 549 and existing Rules and Regulations. JOB ADDRESS/LO N .............. .-_.._:......_-.f.�_... i _��° ._.......__.._.._.......CENSUS TRACT .......................... Owner's Name �L .....-.---- �....... ..........................�W ' `...�_. -..�....Phone .................................... sV�..1.... _..W... �� ... City I Address .:............�--. - ... Contractor's Name .. ---�?�4— -- � f-_.....__.License'# ,�� ._ _. .. Phone .......................... .... Installation will serve: Residence Apartment House❑ Commercial❑Trailer Court 0 Motel ❑Other ------ ------ = Number of living units:.._1...... Number of bedrooms . .......Garbage..Grinder............. 'lot Size ,..10 ... ! •_......... Water Supply: Public System and name Private [�l' Character of soil to a depth of 3 feet: Sand❑ _Silt[] Clay ❑ Peau❑ Sandy Loam 0 Clay Loam 00,11, Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type ........................... (Plot pian, 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 fAl Size. ..... Liquid Depth ....q..................`� Capacity .Patti.. Type ... Material( No. Compartments ....... . Distance to nea e� ,Well ......_r,r�-. Foundation .....1..0.......... Prop. Line ..... ............. LEACHING LINE [� No. of Lines ....... .._..._. Length of'each' line......kQ.-.............: Total Length ........... 'D' Box .... Type Filter Material ...... Depth. Filter Material ...... ........................... 10 Distance to nearest: Well _..... P...__.-:..,: Foundation ...f..................: Property Lina .. ...-......:....... SEEPAGE PIT [ ) Depth .................... Diameter ......... Number.......•...................:_- Rock.Filled Yes ❑ No 0 y Water Table Depth .Rock Size Distance to nearest: Well ........................................Foundation .................... Prop. line REPAIR/ADDITION(Prev. Sanitation Permit T# ............................................ Date ......... ........................ Septic Tank iSpecify Requirements) --------------------•----•--•-••----.......--•_..... .........._.................. Disposal Field (Specify Requirements) ..................... _.......-•-----•....................-•--•-•---•---•-•---------------....------•-•---- ---------------------------------.__._--_.._..._._..__- ......•..........................................................................-................----••-................-.......... ---•-••------ ..................................... -----••---•----- •---•-••••----------------------------------------- (Draw existing and required addition on reverse side) . r I hereby certify that 1 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 liven- 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 became subject to Work n's Compensation laws of California." Signed --•-----------------•- --•-- •• . ....... == l----•----•- Owner i By .......... ------------- � - __.. Title ... J' ...: (If other than owner) FOR DEPARTMENT-•USE ONLY - • - APPLICATION ACCEPTED BY ../ DATE ..1.4.7/17Y....... BUILDING PERMIT ISSUED ............... :. = ..................... ---.__.._... ---...DATE ------;................................... ADDITIONALCOMMENTS ...........:........................................................................-......................................................................... r ...:...:..:. .....:.................:..............................................:....._....._.....................I.............I.......... ` ............................................. ... ....:. .. .. ..• .................. Final Inspection by- -- -- -•:--•---••----•�..:...:..........................:........ .......Date ....-- '-�= ��17--..........------ SAN JOAQUIN L LOCHEALTH r-. Et.13 24 1-'69 i2ev. SMs� ._ AL_��ALTH DISTRICT- _ _ 7172 3OD