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z-FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 4 ...............I.............................. Permit No. ..� .......... (Complete In Triplicate) :...................................................... lb-z�23This 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 with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION f ....,.. _ '"V. .........................CENSUS TRACT .......................... ............................. ............... •---- ...__ — Owner's Name ............... - ---.-.- - ... .Phone . .. Address ...�.� .�..._...,�,�.. ..�.?....:.............•--. City -•- --- •- • -�- - - -..__.....__...._..---•---- -.. .......... . e j , Contractor's Name ._....._..... .�f/I Lte f... '...f-4. a....................License #. .-- Phone V et"�KO7... Installation will serve: Residence Apartment House❑ Commercial :[3Trailer Court l Motel E]Other ----- ..................................... I Number of living units:..._!.__..._ Number of bedrooms ...Garbage Grin r _ _.___.___. Lot Size ............................................ _ Water Supply: Public System and name ......................................................... - ............................................Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ -Clay ❑ ' Peat❑ Sandy loam ❑ Clay Loom 0 Hardpan ❑ Adob0X Fill Material ............ If yes,type ............... (Plot plan, showing size of lot, location of system in relation for wells, buildings, etc. must be placed on reverse side. NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 240 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK Size....... ... ....� .__........_._._..._ Liquid Depth .. .... Capacity A? Type . .._... Material._ _.. No. Compartments Distance to nearest: Well ..................... . 0 ...__.Foundation ----/ _........ Prop. Line _.... _.___• -`.................X LEACHING LINE No. of Lines ......_Zrn......... Length of each line.......... ........ Total Length .....F Type __..Depth Filter Material .------/ .�'.................... 'D' Box ...... . T e Filter Material __��. ..:._.� . Distance to nearest: Well ........................ Foundation ...... ------ Property Line .....s...............� SEEPAGE PIT �, Depth ----- 5 -.-_ Diameter .q.a�. . Number ..........�,l}.r.`....... Rock Filled Yes)Z No ❑ " • Water Table Depth .........................................Rock Size `?� ...._lam ..._... r Distance to nearest: Well Foundation ._-- ':t---- Prop. Line ....4r.............. REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .................................. j Septic Tank (Specify Requirements) Disposal Field (Specify Requirements) ----------------------------------------------------------------------•-......---------...__._........_.---....... _......__..__._ ..............................................•-•-••---•----------------------------.-... ----- .............. ......--------••---••----...---•--......_......----.......----------....------•-----•----... (Draw existing and required addition on reverse side) 1 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 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." I Signed ....................... ........... Owner BY •.............. � •---................=--------------------..__... Title ......-.._ '.............................................. I (If at than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . .. ---------------- --------- -----•---• DATE, �... .. ...Y..�� ... BUILDINGPERMIT ISSUED -----•----•------ --------------• ....__. . . ......-----------•..........---....DATE ... ....................................... ADDITIONAL COMMENTS ----------------------------------------------- ---------- .......- -•---- •....... ........................ ... . . - •-•--- --• . ................ ........... .. . . ...... :.. --- - :. .. .........--- ... _ _ . .. ... ....... .........Inspection by: _... .. SAN JOAQU1N L CAL HEALTH DISTRICT WAO E. H.13 241.'68 Rev. 5M 7172 3 M