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FOR OFFIC.E_.USE: ��yy PPLICATION FOR SANITATION PEfi,,.,,f Permit No. b . . . ------...I.............. ... ... ..................... (Complete in Triplicate) Date Issued .. ./.�. ._....._-------- .------- ......_..._.....__.....__ This Permit Expires 1 Year From Date Issued :�'7Y L 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 withCountyOrdinance No. 549 and existing Rules and Regulations: JOB ADDRESS/1.01 J��ca[.� r --------/i / /CFS'-.--�7�------....CENSUS TRACT ------------------------- Owner's N me -ig_t-✓1. ------L_-/. 1t�'J- --------------------•------------ ----/ Phone ------------------------------- Addresss`� - 113NTLCs �� -------------. City!=lZC�d �7. 1 .. _ --------------- --------------- Contractor's Name Name �.'•<.................._. .....License 4;V3Wf-__.. Phone 40/15v.r1.,7... Installation will serve: Residence[q Apartment House❑ Commercial❑Trailer Court I❑ Mote[ ❑Other ............. Number of living units:_j------- Number of bedrooms ... ... Grinder ..___.__..._ Lot Size ._._...... Water Supply: Public System and name ..------- ------. ------...................._----.--.--------....------..-----.----...----..__....Private ❑ r Character of soil to a depth of 3 feet: .Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam p Hardpan p 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,) G' PACKAGE TREATMENT [ ] SEPTIC TANK[ ] Size.__..._..._.__........ ......._..._...... Liquid Depth ._.__....._...___.__. C Capacity Type - - terial-. -- -_- - ---- No. Compartments V Distance to nearest: Well _...__..___._..... .............F undation ... ......... Prop. Line ...................... 0 LEACHING LINE [ ] No, of Lines ........................ Length o each Ii ..............._._.._.._..._ Total Length ...........__............. _. 'D' Box .._.._____.. Type Filter Materia .............. ....Depth Filter Material .............. Distance to nearest: Well ....__.____ __.__.... Fo ndation __-..._.._...._._- Property Line ........................ SEEPAGE PIT [ ) Depth __..____----_. Diameter. ...___..__.__ umber - .._._.__._...._._..__ Rock Filled Yes ❑ No Water Table Depth .......------ Length/ Acrteria Size - to nearest: Well ........................................Foundation ........._.......... Prop. Line ....... REPAIR/ADDITION(Prev. Sanitation Permit�# ............................................ Date .__.__.------..........---------_) Septic Tank (Specify Requirements) --------------A-----------. ..,.A..-----•-----------------------------�--...---•---------•---..--------------•---... Disposal Field (Speci 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- 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." B Signed - -- - -- Owner - B, - Title (If other than owner) FOR DEPARTMENT USE ONLY 9 APPLICATION ACCEPTED BY _...._.__.... __...._....___--_. DATE ... BUILDING PERMIT ISSUED - - - - ------__ _ - ------- - DATE .. ---- --m_......... ............... ADDITIONAL COMMENTS .----- - - - - - - .... .............. -................------- ---------- - -- ------ -- --- ------------ - -------------- ----------------- --- -------- -- / .... Final Inspection by: --_-. .. . .. _-.- Date _f _I..S...�.. . SAN J AQUIN LOCAL HEALTH DISTRICT