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nFOR 'OFFICE USE: APPLICATION FOR,.SANITATION PERMIT (Complete in Triplicate) Permit No. ...... k ....................................................... This Permit Expires ] 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 trade in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION . ......... ........CENSUS TRACT Owner's Name ............. ,.. ��......__ e..................................... Address ........... ..•------._.._ :�5 e:.C�L�_ �,l. City ___._...__...._..--•-•---••---•----••---......_... ........License # / — Phone Installation will serve: Residence sidence artment House Commercial Trail Contractor's ame _.____._ L�l'Ap �] ❑ er Court Q Motel ❑Other .........................---------- -------- Number of living units---------- Number of bgdrooms ...__Garbage Grinder .oxo..... Lot Size __. d... /__t - ........ y Water Supply: Public System and name .___ �� -5� �-----------------------------------------------------Private El Character of soil to a depth of 3 feet: Sand n 6ilt❑ Clay ❑ Peat 0 Sandy Loam fl Clay Loam ❑ Hardpan ❑ Adobe ' aterial ------------ 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 j Size................................................ Liquid Depth ._.____-. .............. CapacityType .................... Material...................... No: Compartments .........._-_......... 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 ........................ f=oundation ........................ Property Line ........................ SEEPAGE PIT' [ j Depth -................... Diameter ................ Number ....-..........._....--_-.._ Rock Filled Yes ❑ No Q ; Water Table Depth _-__-_ .............Rock Size ----__-.---_--:_ Distance to nearest: Well....... ...............................Foundation ........._......... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation'Permit# ............................................ Date ..................... Septic Tank (Specify Requirements) ...... --------d`� -- -� • •---------- t Dispos Field (Specify Require ents) ...... _ -----•- - -- -•--•-• - mss-- ` -e. ...................... ., .-� ... ...---...--- (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 subiect to Workman's Compensation lowi of California." Signed --••--- --- -----------• ._...... �.... -------• -- -------- Owner By --- ......... • -------------------------- -----------•---• Title _....._._.._...... . ...?-. t!Z../................... .. of er than owner) n ! FOR DEPARTMENT USE ONLY ! APPLICATION ACCEPTED BY . -•-------••-___...-•---•------------------ _ DATE .. .-_�_:��':�.............. BUILDINGPERMIT ISSUED . .---r,......•--- -- ............... ...................•---.. DAT .,._...._._.............. .............. AD TIONAL COM NTSn�.cl.. f._ , �.-LG a . ,.aa.� IVZ� -- -••-•- ----------------------------------•-----........-....---..._..__............. y ---•-•------- ---- •------•-- ----•- _-_Date • --- - Final Inspection b .._ . ..--••-.-•-....--•.......................•.- ... . P y. SAN JOAQUIN LOCAL HEALTH DISTRICT 7/723 N