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FOR OFFICE USE: PPLICATION FOR SANITATION PER ' �€ Permit No. I [Complete in Triplicate] This Permit Expires 1 Year From Date Issued Date Issued __y".3.:... Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herei described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ...... ...._CENSUS TRACT -------------------- ----- Owner's Name .._...... T`7�" . -- - _E_ �_ - -- ---- ----------- - Phone Address -- City -zL�— - --------------------- -- -- -------------- Contractor's Name - C��'�2, 4 .:y- -- ¢- (di p�i'" License # .3F Phone _ ------------------- Installation will serve: Residence rIJ] Apartment House❑ Commercial ❑Trailer Court F-1 Motel ❑ Other ------ --------- --------- -------------- Number of living units:..... Number of bedrooms -__-nq----Garbage Grinder ------------ Lot Size _ _ -4 L'r '-{' :__.____ Water Supply: Public System and name --------------- -- ---- --------------------- - - -------------------------- ----- ---- ---- --Private Character of soil to a depth of 3 feet: Sand EJ Silt El Clay E] Peat ❑ Sandy Loam( Clay Loam ❑ Hardpan ❑ Adobe ❑ 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,] A PACKAGE TREATMENT [ SEPTIC TANK'[ ] Size_______________ ____ . ..... ...... Liquid Depth .._.......__--..__.__...- Capacity ----- -- - -- Type ............ Material- .-- .-- -- No. Compartments Distance to nearest: Well ..__..___._------------------- - ..--Foundation _____ ___ -- __ -- - Prop. Line ---------------------- LEACHING LINE [ ] No. of Lines .. Length of each line.. . . . ....... . Total Length . ............... ..- 'D' Box ...._ _ . Type Filter Material ____________________Depth Filter Material ____.___.____.___..__.___._-___.___.--.-_.-. Distance to nearest: Well .. --- ----- ---- ...... Foundation ________________________ Property Line ...--..---...---..---..- SEEPAGE PIT [ ] Depth ... ................ Diameter ____ ___________ Numbe. .. .. ........... Rock Filled Yes ❑ No i❑ Water Table Depth .........__.... -_ .._..Rock Size __.........._-.._.------ Distance to nearest: Well .................. ............---------Foundation .-------.- -__.... Prop. Line .......-.-_--.-.----- REPAIR/ADDITION(Prev. Sanitation Permit# _______ ____________________ _______ ______ Date -------- ------ ------.----------) Septic Tank (Specify Requirements) --- ------------------ ---- -------------.--------- ---------- ------ ---------- ----,--- ---- --- ------ - ------------ is sal Field (Specify Requirements) _4'.4e - - - X �4D',aw e tiv ng nd 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- 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 ------------ ---------------- .- Owner �� uF�. .z -ps i C''�•+ By -. . ........ f dJ�-� - Title . ------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY . . . DATE .... -� '------------------- BUILDING »- ---BUILDING PERMIT ISSUED .. _... .................._.. ................. ..DATE ADDITIONAL COMMENTS ----------------------------- ------------ ... ... ._. .... . ... . ...__....._....__... -- ._.._... . . --- - - -------- Final --- . j Final Inspection by: t -� - Date ? SAN JOAQUIN LOCAL HEALTH DISTRICT F W 0 1_*AA Do„ FAA