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FOR OFFICE USE: -------- APPLICATION FOR SANITATION PERMIT �,� -3 J/6(Complete in Triplicate) Permit No. . ................... " ". . ------ This Permit Expires l Year From Date Issued Date Issued ..Z_ 74- Application is hereby made to the San Joaquin Local Heal#h District for a the work he described. This application is made in compliance with County Ordinance No . 549 and existing Rulesermit to construct andtalnd Regu ationsrein JOB ADDRESS/LOCATION .. -- ,p y h Q - /Q ••.-......CENSUS-TRACT Owner's Name �� ! x7 ..1 . .1 .............. ,..,.. ........,Phone Address _._, ..• .�` +Y • .P Contractor' , ........._•---- s Name License # ..:.... ...........;�Ce ............:................. Installation will serve: Residence❑Apartment House f] Commercial#]Trailer Court 0 r Motel ❑Other........... Number of living units:....__ ---- Number of bedrooms Garbage Grinder Lot Size /f Water Supply: Public System and name .._--•--••----••----------...................................................PrivateQ_ - Character of soil to a depth of 3 feat: Sand b Silt.0 Pay CJ peat.0 Sandy Loam ❑ Clay Loom ] 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 slde.� 1 NEW INSTALLATION: (No septic itank or seepage pit permitted If public sewer Is available within 200 feet,¢ PACKAGE TREATMENT �' SEPTIC TANK 0 - � 3 Size.............•-----•-•------..._.._........----. Liquid Depth /� -1 ....................... Capacity -1-2-6440-9%1- TYpe ------••••--_-� , Materibl.0 ,, C_r �• No. Compartments . o ....... Distance to nearest: Well __.._� .....Founds#ion .fB-----,... .•, Prop. Line ._. . ........_...(5 LEACHING LINE ,&' No. of Lines .__... __....___._. Length of each line........ t w -.... Total Length �. _.Q._•-•••---.� g ..... 'D' Box ...K5... Type Filter Material /r° rtC .---Depth .Filter Material ..........�� . Distance to nearest. Well .... __ ......... Foundation .._A?............... Property Line SEEPAGE PIT Depth .---- -•---- Diameter ................ Number --------__..._-----------_ Rock Filled Yes No C Water Table Depth Rack Size .. .............. ;ff . Distance-to;neares#: Well-...........:......... �-°� ....._Foundation ....... Prop. Lime REPAIR/ADDITION(Prev. Sanitation I Permit# -.--•- _-----___- - 'Date---------- ---- (Specify } Septic Tank S p � p fy ..Requirements) --------•-------•-�•,y;-•------:... Disposal' Field (Specify Requirements) ............. --------- ______ _______________?__-__-_..__-.____.--___ . t ____________________________________________________________________________________________ _ __.....__.__..__....._._____..___............................................................ *� {Draw existing and required addition on reverse side} ! hereby certify that I have prepared this application and that the work will be done•in accordance with San Jeasquln 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 p'ermit Is issued, l shall not employ any person In'such manner as to become sub ect to Workman's Compensation laws of California." Signed --------- 7- _.� . --, -- -- -z .. - --------•-•--...__---•---..._..___ Owner , BY ----•---•---•-•-------•------� -- -• -------------------- Title ---------------------------------------�' . {If other than owner! ............... FO DEPA T USE ONLY APPLICATION ACCEPTED BY .._._.•-__ DATE ._.....�...r... ._7-. .�_-.. = BUILDING PERMIT ISSUED ...........:....... ------- •--------- ....................*11'r----------•------ -DATE ....... ................. ADDITIONAL COMMENTS --- ------------- --- ........................................................................... _.- ________________- .____.. 4- Final Inspection by: _._.. ..---•----------•------•------•--------- ------------------ - Date _`.may.: ... . ---...--•--- . ' . IH 13 2b 1-68 rev. 5M SAN JOAQUIN AOCAL HEALTH DISTRICT 8/7h 3M