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FOR OFFICE.USE: p APPLICATION FOR SANITATION PERMIT r Permit No. ..��J:�.... ............................ .. . ........ . (Complete in Triplicate) ......................... .......... ... _111._ 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'Ordinance No. 549 and existing Rules and Regulations: s JOB ADDRESS/LOCATION .. .,L•.3.�,�./... �.�.. - V?-'•---��-.:....-•-•............................CENSUS TRACT .:................... .._.. Owner's Name 4 � ........... ............. ...............................,......... Phone ......:........... . // - -- -•...... Address -+- C. Contractor's Name ..... . •n -e QJ �. i " -•..-•................ ----------•_..�.:VA -------------- --------------License# .1-�..:.��--.---�'-- Phone __.. ; Installation will serve: Residence partment House Commercial ❑Trailer Court Motel ❑Other Number of Living units:...._.../._ Number of bedrooms .....Garbage Grinder ------------ Lot Size :...____- Water Supply: Public System and name ...........................:......•.......................................... -------....................:......Private [d� r i * 0_ .� Character of soil to a depth of 3 feet: Sand❑ ilt E] Clay ❑ . .Peat❑'~-,Sandy loam ❑ Clay Loam 0 Hardpan Adobe❑ F111 MMgterial �'_._ `. If yes, type ............................ (Piot 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 orseepagepit permitted ifublic sewer.is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK{&11y Size.4-7-2.. ..:.._:..... Liquid ,Depth 5 .................. Capacity.j: �a . Type . Material .. No. Compartments ._ ............ Distance tb�nearest: Well ..� -?p..—�r_:_ :: Foundotion ..... :....... . Prop. Line .... ...........:.. I .LEACHING LINE No. of tines :.......I............ Length of e6ch line....... .......... Total Length ....... 'D' Box ...... Type Filter Material,-, . A>7.A� ....Depth Filter Material . ..............................•- Distance to nearest: Well ............ Foundation s ...... Property Line �3_.. SEEPAGE PIT ( Depth ----- :_ ..�. Dia meter .... .. .� Number'.._.....- -•- ._._--•_-. Rock Filled Yes No Water Table Depth .6 i Rock Size Distance to nearest: Vell..::.........�. ..................Foundafion ..._)..0.......... Prop, Line ...... REPAIR/ADDITION(Prev. Sanitation Permit ) ...... ..................•...---- Date .--•--............••---------•-- Septic Tank (Specify Requirements) ............................I........................ ......................................................... Disposal Field (Specify Requirements"` - �, -- .. - --..-_�: _ ........... ....... ............................. -- ------ -..................... ........................ ..... .. ...:'.-•------------••...................••---- .:_._...--•••-•._......•-•---. :_..--•----------•-•3....... ................... -.... •-----......................................... .... (Draw existing Arid required addition on'neve"r-se side)- _ rY . ._. _ ....-- - - 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 fallowing: "I certify that in the performance of the work for which this permit is issued, I shall not-employ any person in such manner a as to become subject to Workman's Compensation laws of California." Signed Owner y C BY :. .................••••••. ••-•-•-•-- ... ..... A 3itle ... (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -•-----•----------•-- --' --=- -•--••-••---•---•-•--•............................:....•--•--. DATE ....f'cr. ...Y .:�,.1`..-1..........----- BUILDING PERMIT ISSUED . ..... .. .. ......... .........-- ............... --- •--. ._. ... .....DATE ADDITIONAL COMMENTS ..� `r ��, :.�s� !_. ��rL :...... .........:........• •.... --••-•--...-•••••.................... ........................................................................................................•---•...------......._.........._......_.__..._......--- ................................. ............ .. . ...........-•-•-•-•-•••---.... .....:.............:...................:........::..........--•-----.:...................................... .............................................. ............................... �,.- Finalinspection by: erze .................•... .........................................................................Date ....... ./. .`.; 7 ............. SAN JOAQUIN -LOCAL HEALTH DISTRICT Z3 24 ' E. H. i- b8 Rev. SM 7/72 3�M F�