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FOP_OFFICE USE: APPLICATION FOR SANITATION PERMIT -s-.3•o (Complete in Triplicate) Pevmit No. .-•. .. .... This Permit Expires I Year From Date Issued Rate Issued .. .'. �.:. 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 with County Ordinance No. 544 and existing Rules and Regulations: 3f0C: JOB ADDRESS/LOCATION ........ C -�.s= =.?L' ....-'f?! 5' ................-CENSUS TRACT ..:..:...4.----......... `1r Owner's Name j _ , '` X ..... �. '��,! .•_ . ...-----• . ...............:............ ........Phone Address ......._---------- -11-1.:.r._........................................City .J.. .................................................. Contractor's Name ........ .Zdr.:J.`6. .......License # Phone Installation will serve: Residence [] Apartment House Commercial kTrailer Court Q Motel ❑Other............•.............................. Number of Jiving units:............ Number of bedrooms ............Garbage Grinder ............ Lot Size_c .......h .�`y .: ......... Water Supply: Public System and name ................ .... Private Character of soil to a depth of 3 feet: Sand E Silt[] Clay C] Peat[] Sandy Loam 0 Clay Loam Hardpan ❑ Adobe t] Fill Material ............ If yes,type .....__.................. (J p (Plot plan, showing size of lot, location, ofsystem 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,). PACKAGE TREATMENT [ ] SEPTIC TANK-[ ] Size................................................................. Liquid Depth .......................... 7� Capacity ...............:.... Type --- .......... Material.--.--.--..-. ...... No. Compartments Distance to nearest: Well .Foundation ...................... Prop. Line ...................... LEACHING LINE ( J 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 [ 7 Depth .................... Diameter _............... Number .......__................. Rock Filled Yes [] No Q Water Table Depth ............................ ...................Rork Size ................................ Distance to nearest: Well ........................................Foundation .................... Prop. Line .........__--_-- , REPAIR/ADDITION(Prev. Sanitation Permit#, ............................................ {date ..................................I Septic Tank (Specify Requirements) ..................._.r--------------------*........... . ....................•------- ------ _ Disposal Field (Specify Requirements) ............ ................................. (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. Home owner or Itcen- sed agents signature certifies the following: "1 certify that in the performance of the work far which this permit is issued, I shall not employ any person in such manner as to became subject to Workman's Compensation laws of California." Signed ---•- Own Sy..........---...... Il�r . .. r '�i�!` .....................•......_.... Title ......-P,, ....,.............. ........................ (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-.----.._•......................... ......._... DATE ..................................---------- BUILDING PERMIT ISSUED ...DATE ....................I...................... . ADDITIONAL COMMENTS ........................................................................ ..................................................................................................:..................••---•----_-. --_-•---........------ --------------.------.... .................................•......................:.............-----.__................ . ............ -•...........-•._DIST.R.I.C.T..--- ..._.....------------. .-------- .. . . .................. .................... ...._........ . .. .. ... -•-- . Final Inspection by: ....:....-•--••--•........ .................................••---_ _... . ,. .......----...Date ... ........................ SAN JOAQUIN LOCAL H _ JJ72 3 M