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FOR OFFICE USE: FOR OFFICE USE: �� _ �!f I/ APPLICATION FOR SANITATION PERMIT Q �f ` (Complete in Triplicate) Permit No X_—f;?/. Date Issued/..:.3_::2 ..........................----------------........------- 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 made in compliance with Co my Ordin nce No. 549 and existing Rules and Regulations: J ...._ -----_..CENSUS TRACT--JOB ADDRESS/LOCATIO P- ed � Owner's Name. Phone.. ...... �/ 1�.F. _. .----- Address._,/ _ �. `. __City - -------.. ..Zip_` �o7.0=5 - - -- ------- - - - -- _ Contractor's Name - -license #. ��'✓"�9. �. Phone--f 5 .�/- ....... Installation will serve: Residence K Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other---- - ------------ ------ --------- Number of living units:.-.-------_---- of bedrooms---�_.Garbage Grinder_.........Lot Size_--..��.�.. �_/��-5----/------- --- � W Water Supply: Public System and name_ _...._-...___.__--_.._.�� .J ........... .......Private ❑� Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe Fill Material.- _.. _..If yes, type--- -------------- -- - G `V (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) � NEW INSTAL;ATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size ------- -----_..------------..................-.---------Liquid Depth-------..__.--.-----.---- Capacity------- ---- - --.--.Type...---•--.......__...Material-----------------__---.:No. Compartments.-------- ------------------------- Distance to nearest: Well---------...--------- ----.._.__:.......Foundation.--------- . ._-.. _. .. Prop. Line-.-..---- -.... LEACHING LINE [ ] No. of Lines_._.._....................Length of each line-_-_---.--_..___._...__..---Total Length .___...-..--_- 'D' Box...........,Type Filter Material._.... ..... ....Depth Filter Material.. --------------- -------- ---------- ------------..--------. Distance to nearest: Well.... ------------*-- ------.Foundation----------------------.-._-.Property Line.....-...._.._._-...-...--.------.. SEEPAGE PIT [ j Depth----- ._. .....Diameter-__-..-.----_-_._.Number --- .__-.--__------_ Rock Filled Yes ❑ No ❑ Water Table Depth.................... ---------- -- - -- -------•.......Rock Size.-.. .......... ....._ Distance to nearest: Well_......... ------------------------------Foundation.._....__..._.. ._._.....Prop. Line._..-----_--_.------ _..- REPAIR/ADDITION (Prev. Sanitation Permit#..-..._...................__-._.. _- ............Date.................... ------ Septic Tank (Specify Requirements)--- - j - - �.. - ��3 Disposal Field (Specify Requireme ts) C^ � :-G^�- i ----------------- ---------- ------ --------- ------ --------- ------ ------_..------- ------ --------- ------•---------•-------- ------------ --------- ......--- (Draw existing and re-quired 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 licensed 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 blee t to Wo man's ,Compensation laws of California."�.� 0 __` `-Y , Signed-.._ . - - 4other -- ----- -�.-- ---------- -------- Owner --------- By.......... --- - ------------------------------------------- . Title--- .C�/....... _--------- ----------------- ------- (If , an owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ ---------- ------ ------------- -------___ .............. ---------- ---......DATE ...7 ...._-- ------- DIVISION OF LAND NUMBER. DATE.. ADDITIONAL COMMENTS. lL .. '+�` - ................ ----- -- _----------- --- ------... ---------•------•-------- ----•------ ---------- -•------•--=------ ..........•.... ----- . ----------------------------- ----- --------------------•------------------- ------------ - --------- Final Inspection b __ __ ._Date..._ � ----------- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT EH 13 24 F&s 21677 REV.e/ M