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1 FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �5- ....................................:..................: Permit No. ........ (Complete 16 Triplicate) ...... ............... Date Issued S11=2S� ......... ................................. This Permit Expire_s_I Year from Date Issued Application is hereby made to the San Joaquin Local Health District for a permit. o,construct and install the work herein j described. This application Is made in compliance with County Ordinance No. 549 and existing Rules and Regulations- JOB ADDRESS/LOCATiON P- [•!`- _-• 1 �-------------------- -----.. CENSUS TRACT .!�,asalL....:..._.. �_ Owner's Name L .1..I ....---• ..._.... �.K _ .. ...... ................. .. ...._Phone . -----...�FSI�?_. „� k. -. ?'� ....:_.... --••--...._.City . .-....... �... --------------- Address ......_ Contractor's Name& _ ......... / ...License # S7•-•----•----- Phone 3.475r-. 1 ' Installation will serve: I Residence G40Xpartment House Commercial❑Trailer Court ❑ -, iMote! Other.........-•---...............:.............. Number of living'units:.........�' "Number.of-bedrooms _._3...Garbage'Grinder _-.......... Lot Size Water Supply: Public System and name .................................... .r._.._......._. ..........,._...... - - -.... Private ) Character of sail to a depth of 3 feet: Sand b Silt❑ Clay ❑ Peat❑ Sandy loam Ar--clay Loom ❑ Hardpan p Adobe Fill Material ............. If yes,type Plot Ian showin size-of lot Tlocat!66 of system in relation to wells, buildin§i,-bte:-must............... be��placed on reverse side.) ( p g Y NEW INSTALLATION: f (No septic tank or seepage pit permitted if public sewer is available within 240 feet,) PACKAGE TREATMENT.' ( ] SEPTIC TANK{ I size..............................:..........._..... Liquid Depth .............................. Capacity --------------•---- Type .... .............. Material-- •-------------- No. Compartments Distance to nearest: Well ...................s-------_,.......Foundation ...................... Prop. Line'..k.:.2........... VV LEACHING LINE [ ] No. of lines ------------------- - Length of each line............................ Total'Length -:..............._......;,06 'D' Box Type filter Material ..Depth Filter Material ................� .. `Distance to nearest: Well ............. .t. Foundation ....................-... Property. Line ......................... SEEPAGE PIT [ Depth ---------=---------- Diameter ...........--- - Number ......................... Rock Filled -"Yes ❑ No Water Table Depth .Rock Size --- ..-_-- --Distance to-nearest:-Well .....Foundation . w . .. Prop.sLine w.........'......... ------.--_.___. REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ......•----------_------------___,) ' Septic Tank (Specify Requirements)....:....... •- ----- _ . •------------ -.........................:....................... __._...._..._.....:_.. . DisposalSe.0.41-V sla (Specify Requirements) .��jGT-------------•--•-•��-•--•----- ..._.. .:�...... .............. ------------------------------•-•--:..--------•------------....................................................... ---••• -•------ -••-..----•-------._.....•-----•---------........................... •-----• ----- - . -•------------------- - ------- ------ -- ------....:.......---------•--._-....----...••----......---- {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 Sana 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: "1 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 subject to Workman's Compensation laws of California." Signed --- ----•-- -ei,-------------------------------•-----.----------•--...___ Owner ByB ---------- ed------------------------ •---------------------- --. tle J•-.. C, .. r jlf other than owned ,FOR DEPARTMENY USE ONLY APPLICATION ACCEPTED BY __. _._... -----. DATE .� BUILDING PERMIT ISSUED ------------------------- • ---------------DATE ........................................... ADDITIONAL COMMENTS --------•------- --....- . .......-----•• •---------------I...I__ ------------ G •----------------------•-------•- ------------.......------...--•-•-------................---..._....--..-----•.-_._.-.----•- ....._.... ..... ••-•---•----------•----- •---.....--. ------------------------------.... .... ------------------------- --------------b Final Inspection by: . - .......:_-• .... ............. Date ..................... E'13 2h 1-68 Rev. 5M SAN JOAQUIN LOCAL HEALTH 'DISTRICT 8/7h 3M