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FOR OFFICE USE: APPLICATION FOR -SANITATION PERMIT y y ------------------------------ --------------------------- ---------------- ------- } { E` (Complete in Triplicate) Permit No. ---------I---------------------------------------------- Date Issued i __------------ ----------------------------------- This Permit Expires 3 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein describedcl jhis application is made in compliance with County Ordinance No. 349 and existing Rules and Regulations: JOB ADDRESS/LO ION C. CENSUS TRACT �� • � �•}��- - -r sr�1 ----------- --------------------------------------------------Pch�oIneOwner's Name ------------------------------- Address ---------- Address CitY - - E} f _ ll .License # - ------------------. Phone Contractor's Name ." f� _. _ Installation will serve: Residence ❑Apartment House❑ Commercial :❑Trailer Court l❑ rzll r Motel eOther _. h2�� '''----L— l" _ `: Number of living units./b Number of bedrooms ___________Garbage Grinder ------------ Lot Size ___________________----------- Water Supply. Public System and name ---------------------------------------------- -- - --------------------------------------------------Private _ ,Charatter:of.soil=to-a-depth,of-3.feet:—'Sand-[�^—Sift fl C-lay- 'Peat❑„'Sandy Loani"E] `Clay Loarn �- s Hardpan ❑ Adobe'❑ Fill Material ___________ If yes, type __________________ __ r (Plot plan, showing size of lot, location of system in.relation to wells, buildings, etc. must be placed on reverse side.) V NEW INSTALLATION: (No septic tank or see ge pit permitted 7.2AvS ublic sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK Size`"__ ----"--`--- Liquid Depth * s ) --------------- ------ r ----- e ----- --- No. Compartments ----------:-:-------Ca acitY ----------------- _ Type _-"- _______ Material . -------- 3 istance to nearest: Well __T_---'_____________-______:_____Foundation __._:__________---___ Prop. Line __________._f______ i 1 Len .:. , Q" Total Length - /_��. LEACHING LINE No. of Lines gth of each ,line_____-. .-._, ._ �,d - _. ... %� f 'D' Box ------------ Type Filter Material _-----,~____'__`_Depth�Filter Material_-------------------------------------------- Distance '_ _______________ __ ------------------ _,. . ;. Distance to nearest:.Well a._=.�________________ _!,Foundation --------------____�_____ Property Line ________________--___ - SEEPAGE PIT [ ] Depth -------------------- Diameter------------------- Number.------------------ ___ .___ Rock filled"-Yes '[] No i❑ Water Table Depth ------------------------------------------------Rock Size -------------------------------- ' Distance to nearest: Well ________-__4_______"___________________Foundation --------------- Prop. Line _______..______..-... REPAIR/ADDITION(Prev, Sanitation Permit# ____________________#-------------- -------- Date ----------------------------------- Septic ---------- -------------------Septic Tank (Specify Requirements) -------- - ------ ---------------------------------------- -------------•- ---------•---------------------------- Disposal Field (Specify Requirements) -------------------------i----------------------------------------------------------------- ------------------- -------- - --------- :---------------- -------------------------------------------------------- --------------------------- ------ --- tiT ------.--'— —� wr (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. dome owner or licen- sed agents signature certifies the following: - "I certify that '. he performance of.the work_for which-this-permit-is-:issue-d, l shall no employ any person in such manner as to become. V ec' t[rWb an S,Ce, y nsation� laws of California." Signed -- t� weer __ O r,. �.� BY ---- ------ ---- - - '_�_.__. _ Title _..-- I�-f--- ------------- 0 FOR DEPARTMENT USE ONLY APPL1CA710N ACCEPTED BY ------ -- - ---------------------------------- DATE .1:.- v�------------------- i BUILDING PERMIT ISSUED ------ :- TE , ADDITIONAL COMMENTS ' Q' --- - � o --------- -------------------------------------------------- a + ' nal Ins ection b P Y� ------- -------------------- - ------ -.- ---------------------------------:�------�------ ---� - - -= ----Date ��,-:;------ -------- N JOAQUIN LOCAL HAtTH D! ICT {� _ . G R`NIAl► ,; � , v�{l� off• rl�