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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. . •••�` :.. .... ................. (Complete in Triplicate) Cir r Date Issued this Permit Expires 1 Year From Date issued ..............................I.......... . !:cation is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein App • F described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations. 70-0-0 --77 ,.......CENSUS TRACT ...................-...... JOB ADDRESS/LOCATION .�•--Q-0.0... ... _. ., ._ .Phone . ..:5. __ - S-GL. ,rpt d ........ ................. Owner's Name _...... .... -- •---•-••--•-•...:................ ........... City _ .. . Address ..�G{� ,� ......---•-•••--......... �...... !! Phone . .. q'.� �p License #rQ-. 5 Contractor's Name .r�.u� �• Installation will serve: Residence Apartment House Commercial'OTroller Court . r ............... fes., 7 9 Motel Other .. .. Garbage Grinder . Lot Size ..1�-l/ C� °�• ......""' ❑ U i ter Supply: Public System and name ............... .. Private Number of liven units:... ...--... Number of be roa Wapp Y Y ........................ Character of soil to a depth of 3 feet: Sand Q .Silt❑ -Clay ❑ ' Peat❑ Sandy Loam Clay Loam Q y e ............................ Hardpan ❑ Adobe '❑ Fill Material ..... ...... if es,type y {Plot ,pian, 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 p miffed if public sewer is available within 20a feet,) 4 ,�Da . Liquid Depth 13 SEPTIC TANK I Size....................••--•---............. PACKAGE TREATMENT O � . Capacity Type n. qMaterial(�Ct/y1�ktNo. Compartments .......... � � Pro Line ' .- � _.Foundation `�,�......---•--.._ p. . ----..... Distance to` nearest: Well _. ....Q. .............. # Length of each line ..d.....:........ Total Length . LEACHING LINE [ No. of Lines ... -••••-......• I ...Depth Filter Material ---./... . 'D' Box .../...... Type Filter Material � Z�--••- p ` y Distance to nearest: Well ..//,-5............ Foundation �........_. Property Line --�•••••••-•••• � SEEPAGE PIT [ j Depth •._-_- Diameter ................ Number ............................ Rock Filled Yes ❑ No Q — :........Rock Size •............................:.. Water Table Depth ..................................... Distance to nearest: We ......................................... .................. Foundation ......... Prop. Line •--....---•---•-....-- REPAIR/ADDITION(Prev. Sanitation Permit# .••-•-_••••••• Date ...................................} Q ...-......:.... ' Septic Tank )Specify Requirements) ••-••-•••---••••-•---•--• ..-.-•• . 3 . . •..----• ••-- . . :. Disposal Fiel )Specify Requirements) ................. ... 1 d? u hU-.K. . .. ....... ........4,W... ......... .. .. .. .................................... .... ......... .• (Draw existing and required ddition an rev a si e x I hereby certify that I have prepared this application and that the work will be done in ordance 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 subject to Workman's Compensation laws of California." Signe Owner • Title .................................... By . f (if other than owner) i FOR D ARTMENT USE ONLY ........ DATE ' APPLICATION ACCEPTED BY E ... .... ... BUILDING PERMIT ISSUED . ADD ZONAL C MMENTS . �." + " �L2.�. � ..._ f� rnr�. :.:c:... :A" ,... ' r tM... • �.�..... . -- -Z....�$... a- ... ............. '1 Date Ii /� i - Final Inspection by: ..................`---•-.....---•i.... / �- SAN JOAQUIN •LOCAL HEALTH DISTRICT n� a izo©�z1 C (tt3 " den �G 6viale �7�f 3 r C U 13 241-'AA Rev. SM - -