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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT. (Complete in Triplicate) Permit No. ....�-• -- 3 .................................. Date Issued This Permit Eras 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health district for a per to construct and-install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules oAd, Regulations.. JOB ADDRESS/LOCATION .: ..... ..- ._�r'.,...._ - .........--•...............................CENSUS TRACT .................... Owner's Name ......... . ... } •----... ... .,.............._. ......:__..........Phone . .................. Address -....................... ......o�.- .. -.�.-,/..... ...............•••............. City - .....................................:._............-.:.............. Contractor's Name .........R4 ..... ---------------------------•--• -=---License �l► ./..... Phone' K(P.tl ......... Installation will serve: Residence portment House 0 Commercial ❑Trailer Court 0 Motel ❑Other .....................I....... .......... Number of living units----------1_ Number of edrooms .._.c') _Ga bags nder .--. Lot Size .��„�.�-_.•.:..................... i Water Supply: Public System and name -•--• - _-- .... .-_---....------------------------.....................Private ❑ n Character of soil to a depth of 3 feet: Sand❑ ilt❑ Clay eat❑ Sandy Loam C] Clay Loam ❑ (� • Hardpan ❑ Adobe Ell Material/Y .. If yes,type ............................ (Plot plan, showing size of lot, location ofsystem 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 ...... ............. Type .................... Material...........____ No. Compartments r- 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 ._......... ............ I SEEPAGE PIT ( Depth .................... Diameter ............... Number .... _._._.....:__...__..... Rock Filled Yes ❑ No C] f • Water Table Depth ................-..Rock Size Distance to nearest: Well .................--------•..............Foundation .................... Prop. Line ............ REPAIR/ADDITION(Prev. Sanitation Permit# ........__................................ Date ..................................11 Septic Tank (Specify'Requirements) ............................ ... - -•--. ------- -- Disposal Field (SR cify Requirements) ----- _-- .._.----.'.f 4------ ” � .............................••-•..... /i . --- ------e---------------- --•---......... , s ------•-•.................................. -------_-----------.._.._:....__....._..---- •---------------- - (Draw existing and required addition on reverse sidel # 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 k as to become subject to Workman's Compensation laws of California." Y Signed ..........:.... . .................. .. Owner ..... .. By ..-•.......... ...... . ._ . Title ...__._a.. .. ..................._...._....... ................ .(I er than owner) 1 FOR DEPARTMENT USE ONLY APPLICATIO ACCEPTED BY --- -- - - --- ------ --------------------------------------------------- ----- -------------------•-----•-•-•-----••------. ...... -----...... DATE ...5- � ........-•--._..._..----• BUILDINGPERMIT ISSUED ................................................ .•----•------._..............._...--- ..DATE ._..................--- .....:... ADDITIONAL COMMENTS ...........................................:-.......... .-------------.............---..........-•---.... ...------•----------•........... ....................................................................------------ ....................._....................................•..........•--........................................... ................................ ......... . .. -- .. . Final Inspection by: ... _.Dat,, . ..1-� SAN JOAQUIN LOCAL HEALTH DISTRICT : 1 1 26 , -_ e.. 7/723M +