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• FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Per No. ...7y (Complete in Triplicate) . . ....................•........ Date Issued .�...�.•--••. This Permit Exp ires I Year From Date Issued Application is he 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 CENSUS TRACT ... OB ADDRESS/LOCATION -- Owner's Name .i ufA l ..........................:........ ....... ane ..... I3�c Address _ .....__...��....._ ... City . ............ ... _ _-- --•�. :{`__-......_ Phone C--ontracm s-Name r _.��. .............. ........ 3'; ► i, Installation will serve: Residence A artment House Commercial ❑Trailer 69uplo Motel ❑Other ..........•................................. a Number of living units:......1._ Number of bedrooms H.........Garbage"Grinder -1-455' Lot Size ...1 �i�� `............ Water Supply: Public System and name _.• - - -•----..._.._*,_. ...--•----.. :._. --•----•-•---.......---••-------------- ---•-•. .. .......... Private bry Q i Character of soil to.a depth of 3 feet-� Sand❑ Silti❑ Clay ❑ Peat❑,,/� Sandy Loam _ Clay. Loam ❑ Hardpan E] Adobe, Fill Material _14�.(!'..__ If yes,type .......... ......._----- s (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 tonk,or seeps 'Pit permitted if public siW—er is available withi 200 feet,) X - — ___--. Li uid De th _... --•.--- PACKAGE TREATMENT [ ] SEPTIC TANK Six®---.. .... 1-•--•----- q p1 . Capacity l . Type Material.. � C - - • No:r Compartments ............ 4— � . �� ..Foundation f� . ...'Trop. Line .. .. .... istance to nearest Well ......:.............. 4 LEACHING LINE [' No. of Lines .....� .......... Length of each line.---- �................ Total Length 11/ -•----.... � ._ `D' Box�� Type Filter.-Mafierial �� Depth Filter Material _--_-. .�..................f........... w ' _ Foundation Property Line �— T Distance to nearest: Well ' /� SEEPAGE PIT [ ) Depth Diameter •.__.. Number ............................ Rock Filled Yes (3 No t,] ................. . Water Table Depth ...................Rock Size ............. ................... Distance to nearest: Well _.Foundation ........ Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ................----.._.._... ......... Date .................................... • k Septic Tank (Specify Requirements) ............... •---_..:.::.--•........t.......t.. •. .............. .... _ ----- •--•--• ! Disposal Field (Specify Requirements) ' .-...........................•......... --------••••• ............. ................................ ... .. ...... .......... ... . . .. ••-•-----..._._............... --- (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 lican- 1 sed agents signature rtifies the following: "I certify that in the erformance oft ork-for which this permit is Issued, I shall not employ any pa�so�, in such manner as to bec o Workma 's C ensation laws of California." V Signed •. ---... .. - caner �,. - Ole ..................................... -----......: ....... r,t ......................... (if other than owner) —..—,,-, FOR DEPARTMENT-USE ONLY DATE 7 APPLICATION ACCEPTED BY ............T.! . .- ':-....--.... ...... BUILDING PERMIT ISSUED ..............DATE ._._...__.....__......_....-......__....... I ADDITIONAL COMMENT "� j -•---••-------------•--•--•---- •---- - - .....:--_...-------......----•••.._....... ,...............................------- ............... ------------------ . a Final Ins ectian - Date ... ........ SAN JOAQUIN LOCAL HEALTH DISTRICT 7/723M --