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Ir -,FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 3 Permit No. �'�a (Complete in Triplicate ------------ ------ --------- ---------------- ________ _________-.______-___.__.____.______________ This Permit Expires i 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 made in compliance with County Ordin�e No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCCAAjTION .- RPfie____ _ -------------------------------------CENSUS TRACT -------_---------_------_. Owner's Name - �, _ -t j. -o-- --_4- _A I_ ------------------------------------------Phone Address --------------------------------- -----------•--------------------------- - ----- ------------ City� _ Contractor's Name License # jl,✓r Phone , Installation will serve: Reside nceWApartment House❑ Commercial ❑Trailer Court Motel ❑ Other -------------------------------------------- Number of living units:.__,_.__ Number of bedrooms 2-______Garbage Grinder�[�� Lot Siz _ _______________ Water Supply: Public System and name a*__ --- ------------------------------------.-------------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 __________________________- �1 (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side,) C NEW INSTALLATION: (No septic tank or seepage pit permitted if publicp sewer is available within 200 feet) a PACKAGE TREATMENT { ] SEPTIC TANK Size4(� X-s.4 --------------------- Liquid Depth �................. {� Capacity/ge - Typ � _ Material_ ____ No. Compartments -______________ Distance to nearest: Well ____- ��-------------------Foundation Prop, Line LEACHING LINE X No. of Lines __/'________________ Length of each line____ �_ __``�� - - -- Total Length,��d------------- Y p � u p D' Box T e Filter Material a th Filter Material �______________ ____________________ Distan a to nearest: Well -_ _____________ Foundation _ _>�____ -_______ Property Line SEEPAGE PIT Depth --04.–--------- Diameter �----- Number ------------___-._'______ Rock Filled YesW No Water Table Depth -----410010P-_�-----------------------------Rock Size __-c-_ ---lee--------------- � Distance to nearest: Well -_r________________...Foundation ZoQ__01._--- Prop. Line --- REPAIR/ADDITION -REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------------------------.._____) SepticTank (Specify Requirements) -------------- -------------------------------------------------------:.------------------------------------------------------------_--- Disposal field {Specify Requirements} -----------------------------------------------------'------------------- ---------------------- --------------- r ----------- - -- ---- -- ------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------- (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 subject to Workman's Compensation laws of California." Signed ------------`- Owner By --------------------- -- - --- Title --- the than owner) — rA�''r MENT USE ONLY APPLICATION ACCEPTED BY --- ---- ------ ---------------------------------------------- DATE ----//---- ^/�------------ - --- - - - --- - BUILDINGPERMIT ISSUED ----- ---- - =---- -- -- ---�' -- ------------- -------------------------------------------------DATE ------------------------------------------- ADDITIONAL COMMENTS ---- ----- - -- ------ -------- -- -- -- ----- -- .....l f / ------------- ----------------------------- ---- A ------------- ------ -- : __ __ _ _ ___ : ______ :_______:____..__::.__._____: ------ ----- -- ------------------------------------ Final Inspection -- ----- . ------------- - ------ -- ---------- -- --- - Final Inspection by: - - --- ------------------Date - f ------ - - - -=---- -- - --- - ------. . .. SAN JOAQUIN LOCA HEALTH DISTRICT G_11 E. H. 9 1-'68 Rev. 5M