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FOR OFFICE USE: ......................................... APPLICATION FOR SANITATION PERMIT I Crtihplet*4n Triplicate) Permit No. ._........-...... . . This Permit Expires 1 Year From Dat*Issued Date 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 mode in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ......Q,A.�/J..- ....../.?w..........................................CENSUS TRACT ................... Owner's Name .................. ----•---•-•-.......................................----------......................Phone Address .........-•............... City .... -!L ._....1�ry .,_.........-...... Contractor's Name �i 4~_fes... T"% -----Tfj'1i/X_.,5 :...............License 177fSL3... Phone Installation will serve: Resi.dencejffl Apartment House] Commercial OTrailer Court ❑ Motel ❑Other ...._..................................... � f Number of living units-1,-------- Number of bedrooms .._____Garbage Grinder Lot Size ....L../ ..................... Water Supply: Public System and name --••-------- .............................................................................................. Private Character of soil to a depth of 3 feet: Sand.( Silt❑ Clay ❑ Peat❑ Sandy Loam fl Clay Loam ❑ Hardpan❑ Adobe❑ Fill Material ............ If yes,type ............... ............ {Plot planshowing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.)10, O NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,} r PACKAGE TREATMENT SEPTIC TANK r Size.- --- --- ...�l .� -.......---- Liquid Depth ,may�............... - - -- Capacity ---------- Type ° t Material .cSC_ia__....__ No. Compartments ..W:�.............. Distance to nearest: Well ___ .�Q-� Foundation ....l ........... Prop. Line ._.,5............. LEACHING LINE No. of Lines ..-_. ._ . _. 1 Length of each line ................ Total Length ._. ........... 'D' Box .,/E�. Type Filter Material .Ao.c.•k__...Depth -Filter Material .............................. Distance to nearest: Well ------.- Foundation .../0.............. Property Line ..51.............. SEEPAGE PIT [ } Depth -------------------- Diameter .-.-----.----- Number ............................ Rock Filled Yes ❑ No ❑ Water Table Depth ......Rock Size Distance to nearest: Well ........................................Foundation ..................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ...._..•..._.............•-___.-_.......-_-- Date ................................... SepticTank (Specify Requirements) ----------------------------•.............. .......................................-.........................-............................... Disposal Field (Specify Requirements) -----_----------------------------------------- •--•--•------------•--...-.......................................... ............... .. -------------------------••---- ---------------------------------------- ........... -.._................................... -........_...----.................-•- (Draw existing and required addition on reverse sidel 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. Horne owner or iken- 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 orkman's Compensation laws of California." Signed --------- ............ Owner Owner -- - By - •------------------------------------ title e_ /�---...------------------------------ (if of r tha wwnerl "2� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------- ----- ! ------------------------------------------------------------ .,--..------------------••---•-•----------------------- ------------------ DATE ... .9 .�b.�,Z,6 --------,-.._.._ BUILDING PERMIT ISSUED ----------------------------------------.-.--------------•-- --...------------------- ..-----• ---- -DATE ------------- .......... ADDITIONAL COMMENTS - -------------------- •-----•------------ ----------------------•.......................... -k ----------- •------------------ Final Inspection by: ------••------------- ----..._--------....-•-•-_..... it . 13 Ft ---------Date ....- --�a/T�---••-------------- EH 13 2L 1-6ev. i SAN JOAQUIN LOCAL HEALTH DISTRICT 8711 3M