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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ..... ......... ............I....................... (Complete in Triplicate} Permit No. 2......�....._ ____-__ This Permit Expires I Year From Date Issued Date Issued .. ........ .. Application is hereby trade to the San Joaquin Local Health District for a permit to construct and install the work herein described, This application is made in compliant with County Ord' anc No 49 nd existing Rules and Regulations: �p JOB ADDRESS/LOCATION .......,...,�.�................. .. _. .............:....... ... ..._.... .. . .: ....... ENSUS TRACT .......................... Owner's Name .............. .,r........ ... ..............---------------- ...--. ----Phone -9_�r f. AddressU i ---------------------• _------- ............... Contractor's Name .- .. ....I-- --- --;-A—. ,..,�61 .......License # Phone 'J.,? . ... Installation will serve: ResidenceXAportment House❑ Commercial ❑Trailer Court fl Motel ❑Other --•................ ................•--•-- umber of living units:___ __._ Number of bedrooms _......Garbage Grinder Lot Size Water Supply; Public System and name . "4 -.......a)".. _._.__.._...___.._.___.................... .....................Private ❑ Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam ❑ Hardpan ❑ AdobeX 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 [ I . SEPTIC TANK I ]"i's 7_4kwie..... l� .._... liquid Depth .. ............. Capacity 47op fsf,!� Type.. . . Material-----.---------....... No. Compartments Ate.......... Distance to nearest: Well ....................................Foundation ...................... Prop. Line .._.............__....� LEACHING LINE � No. of Lines _.._ ............. Length of eachi line._:_. ..�....__ Total Length 'D' Box ` ".. Type Filter Material �_.� _-- --------Depth Filter Material -f�................ . .........,.� Distance to nearest: Well . _. � . Foundation /257................ Property line ..43 ............� SEEPAGE PIT Depth ..t 4s'`.... Diameter _` .. Number .........�................ Rock Filled Yes No (�Q Water Table Depth ------•-- 21•-------•-------------• I....Rock Size ....X. -- ................ Q . Distance to nearest: Well _., _. f.�._.__...Foundation ..l� .�...... Prop. Lina .......�y REPAIR/ADDITION(Prev. Sanitation Permit# ......... //_______ D-ate-.-........_................... Septic Tank {Specify Requirements) AUQ. .. ...._......r.)r,1512. � � f... Disposal Fiel (5 cify R quir ents) - - - -- ---..-- -�... ........ �.... ..._..�' -- - ..... .� ... '� ._.. . _ ........ ... a ----------------------------- --- ---------------- _ .....................................................--------.............................. (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 .__.7__ Owner ---- ------`•- - --- . BY `._ �:C�4[ �._.1.. ... ---•--•-- Title .. i-� (if other than own R DEPARTM T USE ONLY APPLICATION ACCEPTED BY _. . ........... ....... ---•--•--•-•-•-• ------ .................................... DATE Y.—_ 2. ...............:.. BUILDINGPERMIT ISSUED .....----•---•---•-•-•••-• . •................•--•... ...... ........................ ..........DATE ........................................... ADDITIONALCOMMENTS ...................................................... ....................... -------------------------------------------------- .................... .......................................•....... ........... ................ -•--- .---....... .............. .. -•---.---•-- Final inspection by: ....... iL.l- - - -- ---- -------- - .......................................... ...... ate ta...._r ..................... SAN JO UIN LOCAL HEALTH DISTRICT f•�, E. H. 3-3 .24 1-'68 Rev. 5M 7/723 ,4