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rUK UFFiCE USE: ............................. APPLICATION FOR SANITATION PERMIT •. .......... •, Permit No. 12`16�.. (Complots in Triplicate) ••.......................•------........------........... This Permit Expires ] Year From Date Issued Date Issued _. 3...............S 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. 5.49 and existing Rules and Regulations: JOB ADDRESS/LOCATION,„..._I.... �7 I! /,��..1-.--._.p�.i�fL.ve_,..._....-•----------•.._..._....-•..........................CENSUS TRACT ........................... Owner's Name ................... 9=AX4 a. �I. .L F-. ....................... Phone.........................•..... ....--••-•--•---- .................. Address, ._.._...-------•------•- ....._ _�f'YI ..._..-•• ��"?rarp_ •._.. City -•-• -•----....•••- . ... /- ..... Contractor's Name ............. _X11... ?1_ !.. 4r�—f-PI/License ,# . Phone"”" hone Installation will serve: Residence Apartment House❑ Commercial❑Trailer Count ` Motel ❑Other ............................................ Number of living units:....1..... Number of bedrooms .........G gyGr der izeWater Supply; Pubfic System and name ............ � ill ' *A" .•••••-,•••••••-,•,Private ❑ Character of soil to a depth of 3 feet: Sand 0 Slit❑ Clay [] Peat❑ Sandy Loam ❑ Clay Loam 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer Is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK) ] Size------------------------------------------------ Liquid Depth .................... Capacity -._ Material...................... No. Compartments ' -------------------- Type ..... ........ Distance to nearest: Well ..........•....... ---...............Foundation ..........--•- -- Prop. tine .....................'J. LEACHING LINE [ ] No. of Lines ........................ Length of each line.................... ..... Total Length ............................0 'D' Box Type Filter Material .....------• ....................Depth Filter Material ............................................0 Distance to nearest: Well ........................ Foundation ........................ Property Line ........•,............. — SEEPAGE PIT ( j Depth .................... Diameter ................ Number ---------------------------- Rock Filled ,Yes ❑ No ❑�' Water Table Depth -------...---------------------•-•-•,__--__......Rock Size ..----,...................._ (�1 Distance to nearest: Well ........................................Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# --------------.----------------------------- Date ..................................11 Septic Tank (Specify Requirements) .... 45k i ........... -------------- ••.--.......... ..... .................... �- Dimosal Field (Specify Requirements) 1 ------3-`-- --------.-•.....................................•--•--.. .---..-•••----------...__._..._.......--•-------............................................................ .................................... (Draw existing and required addition on reverse side) 1 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 beEame sub o Workman's Compe tion laws of California." Si red _.._ Owner R By ---------------- ------------------------------------ Title . - -------•--- (if other than owner) FOIL DEPARTMENT USE NLY APPLICATION ACCENTED BY .... .... ...... .........-•--........ DATE ..... ,...-..... BUILDING PERMIT ISS ED ................... ......................----DATE ...___..... ............_. ADDITIONAL COMMENTS ............................ _ ..............I..................... ................ . r ..__.... ...... .. .........__....._..._................ ..... - •.......... .. . Final ins ection b O ' ' p y . .. .......... ..... .... .............................pate ...f�_....{ ....._......... SAN JOAQUIN LOCAL HEALTH DISTRICT