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FOR OFFICE USE: + '+. ._,,?PLICATION FOR SANITATION PEk _,T �- . ................................ Permit No. ..;? ......--- .. (Complete in Triplicate) .................. _................... / a 7 .........................--....._.......-----....._._.. Phis Permit Expires 1 Year From Date Issued L' E Application is hereby made to the San Joaquin Local Health District.for a per to construct and ingo j work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: IN a � �� ••.-.JOB ADDRESS/LOCAT � ---- -- . CENSUS TRACT .._... ....... Phone _.:. :...-Owner's Name ...... .... . ..._ . .. .......... -- . ....._.. Address ... .. Cif iA _ ............................. . .................. Contractor's Name '? g.License # :-- Phone Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court i❑ Motel ❑Other ......... ................ ........ Number of living units:.__..._-- Number of bedrooms .':_-_.Garbage Grinder ............ Lot Size ,. _._....___._ _-- ............... Water Supply: Public System and name .............................................------- ------------ ----•• -----------•--•-••----- ------Private Character of soil to a depth of 3 feet: Sand[3 . Silt[D Clay ❑j, Peat❑ Sandy Loam 0 Clay Loam 23-1 p Hardpan ❑ Adobe C] Fill Material ............ If yes,type ._._....- ........... (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 tank or seepage pit permitted if public sewer is available within 200 feet,) W PACKAGE TREATMENT [ ] SEPTIC TANK-{4-`-' - ............. Liquid Depth __ ... • ................... Capacity, _m.4�. Type `-. Material...�f^ .. No. Compartments `�n........... �-- Distance to nearest: Well ........- __ ....----Foundation ....l.P1_1......Prop. Line ......... .......... --- Length of each line-------- ------ Length 1.�= ....... LEACHING LINE (� No. of Lines .._.--�.._.._ �° -... Total Len ��.. . -�' 'D' Box ....: _ Type Filter Material - -......Depth Filter. Material 1. .:......................._........ Distance to nearest: Well ._.:_ �..I..�_...... Founclatio 0 f" ...... Property Line `� ..:..... s SEEPAGE PIT [''1 Depth ....�.�� Diameter .�jl.�..:.: Number _._... ..:............. Rock Filled Yes I O ....-----Rock Size ---l.l '. • Water Table Depth ............. ----• •-----• - .^. �_.~.. Distance to nearest: Well..............110A?. ...--.........Foundation Prop. Line .......... ---------- REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ..................................... Septic Tank (Specify Requirements) ------------.....................................................................................I.......... ...... .................. - 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 licen- ied 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." r ' Signed _ / ::,.._. Owner BY � W.................. Title �"�...................... ................ . i Of other than owner) FOR DEPARTMENT.USE ONLY' APPLICATION ACCEPTED BY ........ ----------------------..........................I... ...... -........... DATE . .... ..:Y.�� _........._.__.. BUILDING PERMIT ISSUED ........ ...............:..............DATE ------ ............... ...... ADDITIONALCOMMENTS .......... ................................................................................................................................................. -•------------------------------.._............-------I•--••....-•-----•----•-•----------- J................................................................... •-----••.._...--••--•--------------••••••...._..-••------....--------------•--...I—----,----------- .......... -----------------------•• ................ Final Inspection b - ---------------------.............__...--- • •. ..Date - = .r?................... SAN JOAQUIN LOCAL HEALTH DISTRICT