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FOR OFFICE USE: APPLICATION<FOR SANITATION PERMIT a Permit No. ............................................. '(Complete in Triplicate) .. ............. ........................... This Permit Expires 1 Year From Date Issued Date Issued =.73.. Application is hereby made to the San Joaquin Local Health District-for;o ,permit to construct and_j.nstal4 the work herein described. This application is made in coo�mplionce,with Countty''Ordinanci,No. 549 and existing-Rine-S'iond<RLfgulotions: JOB ADDRESS/LOCATION /..e ?/_//., `....... /.:.. ............................................CENSUS TRACT ..- Owner's Name ...�Ai:7.y.._�.. / . .. .. �7i _................ .................... .......Phone .........._..................... . Address ....... _ ...... .....��:+........................ City .+..pTA..�.�n, ........................................ _. Contractor's Name ... ' .. t license #a`l^/�._,/ ±. ��. Phone !O. .'.:.n"Z4 Installation will serve: Residence[g'Apartment House 0 Commercial❑Trailer Court 0 - �• Motelj]Oth;r .....�,.�.- - y--- - Number of living units:.. ..... Number of bedrooms ..00?Garbage Grinder�/ .._ Lot Size / :. . Water Supply: Public System and,Home ........ ........ :. .cy:: Private .... Character of soil to a depth of 3 feet: Sand. Silt i ❑, � , -Clay ❑ Peat❑ Sandy loam ❑ Clay Loam ❑ Hardpan Adobe Fill Material ....____._ If yes, type ......:............. f . (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 seepage,pit-permitted if pubiic,,sewer is available within 200 feet,) PACKAGE TREATMENT, [ ) SEPTIC TANK�y� t: s Size... .. .. . u 1"t ��t T......... liquid Depth -f!. ....:....... Capacity/Z"' . --; Type4*,A Material dAoAlf-e..... No. Compartments .. `�,........... ry Distance to' nearest:1 Well F.. Q-.-, .�/ , ___.,.Foundation ...ZO.'....... Prop. line ..ano._-�...... ' LEACHING LINE No. of Cines .....0_1./..,.. . Length of each line..... Total Length .............. { D' Box/r'--D.. ,Typt1 Filteraterial / 'O..Depth Filter Material ! �..:_...... .. Distance tb''nearest: Well ....... Fbundation ......./ I � // -- ... Property Line ..+�_4........... SEEPAGE PIT [� Depth .. st`:�:.. 'Diameetter 1.1: iI ..f-- Number:..-:_" ._............. Rack Filled Yes,4 No Q n Water Table Depth . ,....fps ...Rock Size l/cwt........... . y Distance to nearest: ............. .......Foundati&n " 1� .. Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# .......N%-. .... ..............1..:-Date—.-ri:.........................1 S Septic Tank (Specify Requirements) .._...... :........:... . --.--,- , .......................... ...... ... .. -----•-...._..I............................ Disposal Field (SpV4 lRequirements) .............................. - ..,..... -......-•--•.......................................... ......... r.. ^ f ................ /. —.......... ___.............._ __ + .. . a !f(Drawexisting 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 Son Joaquin County Ordinances, State Laws, anti Rules and Aeguiafions of the San Joaquin'Locai Health District. Home owner or licen- sed agents signature certifies th'e follo%[ing: - "I certify that in the performance of tha4work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ...- ......_ ... . . , ... - ........................••-----...- Owner By ........ ..........._......... ..... ------::............_.. Title .. .. (If oth hon owner) t._. . ... .d�..._e.-....----• -`------..... R DEPARTMENT USE ONLY C APPLICATION ACCEPTED BY .. ... . ........ BUILDING PERMIT ISSUED . ......................•------.......a DATE ......... '1�- i��.....:.......... :.....:.................._..................-•---.r..........:__DATE .•• -................... ._............ ADDITIONAL COMMENTS ..........:...............':...,.....•----............-----.._._........................ .r........... ........................................... .......................... :......--------............._......................................_...:......... ...... ...... ---•..............................I._......:...:__.. ................ ....-............ .................................. . . . .... ................. . ...... Final Inspection by: ......... ....:.....................................--- --- Date ,tri .�. .. ...... --_ .'SAN,JOAQUIN;LOCAL_HEALTH DISTRI&t'�