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a `- FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ............................................ Permit No. ..� ..........I——..........I...............I.............. (Complete in Triplicate) " 60""' Date Issued ....................•--.................................. This Permit Expires 1 Year From 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: JOB ADDRESS/LOCATION ......� .,... Jc...(Q. ..... r Tf��11.�J......................CENSUS TRACT Owner's Name ...... 1............. h y`F ......................................•...............................................Phone .................................... Address ............... .�r�.�ir�r-------- G' e!o .................... T _ City .../3. ?...f..i�U...............•------............................. Contractor's Name � a I! . . ..License # .`�? F' _. Phone Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Court Motel ❑Other ............................................ Number of living units..--./...... Number of bedrooms ........Garbage Grinder ¢_......__. Lot Size _ _ .1,6 .................. Q � 7T.e �5.._C C.�............. Water Supply: Public System and name ...........�tATlI .�_...._ ...............Private ❑ Character of soil to a depth of 3 feet: Sand T3 Silt❑ Clay ❑ Peat❑ Sandy Loam f@ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ............ If yes, type -_------------------------ {Plot plan,. showing size. of loft,.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,) PA- KAGE TREATMENT [ ] SEPTIC TANK{ ] Size................................................ Liquid Depth -------------------------- Capacity ...___._ Material...................... No. P Y -•- Type ------------ Compartments ...................... Distance to nearest: Well ....____Foundation ........................ Prop. line LEACHING LINE [ ) No. of Lines ------------------------ Length of each line-------------------........... total Length ............................ 6 D' Box Type Filter Material ....................Depth Filter.Material ............................................ Distance to nearest: Well ........................ Foundation ........................ Property Line .................I....... ..:. Diameter Number Rock Filled Yes No SEEPAGE PIT [ ) Depth .....:.......... ----••---------. ..-•-•-•------....._._..._.. ❑ ❑6.. Water Table Depth -----------•............._.....--------••-------Rock Size ................. ,................ Distance to nearest. Well ...................... .......Foundation • ....... Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .....__..._......................I Septic Tank (Specify Requirements) .................../_a.,e�... _....T .:....................... .•--.......................... Disposal Field {Specify Requirements) -�--------3�----:0..-• ... ........... ------------------------ -----------•----------- .........................................................-------------------------------------------------------- - (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 licew sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not emptey any person in such manner as to become subject toWorkman's ompensation laws of California." Signed •-•--•------- -- �- -�---� ........................ .............. Owner BY ---------------------------------------------- Title .................................................................... (If other than owner) •--- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ' ......DATE . BUILDING PERMIT ISSUED ...._____-. -__- ..... .... . . _ _. - - - - -----------------------•------•-•-••-------------------•----------------._............DATE .......... ..............:.: .............. ADDITIONAL COMMENTS --••---•..........-•-•---•.................................... .........................................................•-................. -•-----------------------------•--•---•--------------- ............................................................ ......... ....................... ....-----......... ,( Final Inspection by. .................... _. .Date 71 .- ---------------------------------- SAN _. - -----------------------SAN JOAQUIN LOCAL HEALTH DISTRICT E..H.13 241•'68 Rev. 5M _ 7/72 3 M