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FOR OFFICE USE, \ I APPLICATION.ON. FOR�SANITATLON PERMIT ----------------------------------------------- ---- Permit No. _�a_--- {Complete in Triplicatel"" iy ____________________ This Permit Expires 1 Year From Date Issued 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�6 fA-County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATI. .........- �',%/'� --- - CENSU5.TRACT-- Owner's RACf_ 1X . Owner's Name ------ -- �1.�----- - -------�1. - -- --- ---err-- ----------- -----�------------ ---.Phone --'-----------------------•--------- Address itY , CCt�_ Contractor's Name ------------ V F!1-- -- -------------------------------------License # #/- hone Installation will serve: Residence partment House❑ Commercial ❑Trailer/Court ;❑ Motel (],Other.' --- --------------------------------- Number of livingunits:------ Number of bedrooms -- __ /� 2 � ____G ge Grinder _�__ Lot Size /-_�_�____�/�j__-- Water Supply. Public System and name __ _�, 4_____ f�_lrt� _t-!_ _ -_--(�'�______________Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay Peat❑ Sandy Loam ❑ Clay Loam ❑ r:a Hardpan-❑— Adobe • -fill Material W0_ If yes, type _________________________ __ (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) septic tank or seepage pit permitted if pub is sewer is av ilable within 200 feet,) NEW INSTALLATION: (No PACKAGE TREATMENT { ] SEPTI T.'NK'f ize________ _._ _ .. V.4;;�_____._____ Liquid Depth Capacity __ --- _____ __ Type11401s� Materi I-._ No. Compartments .... ..___.- O c � . C Distance'to nearest. Well _____-___ ---------------- Fo rdation�j___ a__ _____ Prop. Line JS__�_:__...... LEACHING LINE No. of-L`ines ----- --------_ Length oft each!li e.'� s� - -Q- - Total tengt D'' Box l_ .Type Filter Materiah 1�__ .- _Wpth Filter. Material _____ __._J.....................,__._ Distance o nearest: Well ____________ _____r _ Foundation . _-_.__ _�___ Property Line ---�f._._,._-___ SEEPAGE PIT V Depth {fit- I ____ ___ Diam er r ______ Number __ Rock Filled Yes ' No Water Table Depth --------- -------______________________Rock Size ---------- Distance - Distance to nearest: Well --------`---___________________Foundation ------/. ----- Prop. Line -__ ---------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ______________________________--_} r `Septic Tank {Specify Requirements) ------------------------------------------------------ ------------------ ----- - _ y _- - Disposal Field (Specify Requirements) ____________ 6 - _p._ ,n_ _— _ -`------------------------------ ------------------------------------------------------------- --- - --------------------------------------------------------------------- (Draw existing and required addition on reverse side). I hereby certify that 1 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 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.'! Signed ------------------------- -- } k : ---------------------------- - ------=----- Owner I � t ----------- Title ------- -------------------------- (lf other th n o r) FOR'DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------------------- °--------------------. DATE --------------- BUILDING PERMIT ISSUED -------------------- -- -- - -- --------- ---DATE -------------------------- --- ADDITIONAL COMMENTS ------------- -------------------------- ---------- -- ---------------------------------------- ------ ------ ------------------------------------------------ ----- _ ' __ - - -_ -------_-- --------------------------------------------------------------f ------------------------------------ --- - -e1- --- G:J-- - Final inspection by: �___f______._ - - -- = -.Date ----------------- ----- SAN JOAQUIN,,LOCAL. HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M