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E. . EOR OFFICE PAPPLICATION FOR SANITATION PERMIT ... u.....�...�. ..................... Permit No. (Complete In Triplicate) _ ............................. This Permit Expires 1 Year From Date Issued Date Issued .. ................. Application is hereby made to the San Joaquin Local Health District for a permit to construct aastatl the work herein described. This application is made in comph nce with County Ordinance No. 544 and existing !lutes and Reguiatlons: f � ` JOB ADDRESS LOCATION �.2.I_.. ................CENSUS TRACT ................:......... Owner's Name ............... rte .....__... . ................:.....�. o ................Phone Address ............ .......y.. ----.------ -- --- - `----••---------- ----- --•- City .. .r......................................... Gntractor's Name ............... :� ,.:.. ._. ..9``. ....,...License ...... Phone Installation will serve: Residence,VApartment House f) Commercial OTrailer Court 0 I Motel ❑Other .-"... ..................................... Number of living units:___f------ Number of bedrooms 0......Garbage Grinder ............ Lot Size ........... * .......I........ Water Supply: Public System and name _....................................................Private J[ Character of soil to a depth of 3 feet: Sand❑� Silt❑ Gay ❑ Peat❑ Sandy Loam o Clay Loam m, Hardpan ❑ Adobe 0 Fill Material ............ If yes,type............... ............ (Plot .plan, showing size of lot, location of system -€n 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 240 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK-* Size........................." ........... Liquid Depth .......................... ......................._6 Capacity'----------------- Type .. Material.._................_._ No. Compartments jDistance ito nearest: Well ....................................Foundation .... Prop. Line LEACHING LINE No. of Lines -------- Length of each line.... _.......1. Total Length .._.._.�..�....... ` 'D' Box ' -f__... Type Filter Material Depth Filter Material 8.��.......................... ¢ Distance to nearest. Well _ t .. ...... Foundation Aation "-"... --------- Property Line ....../...Q...........� SEEPAGE PIT Depth �� f...�. Diameter `�.... Number ---....._/--.."-__--..-_-- Roc Filled Yes ] No ❑ Water Table Depth - ----------•.................Rock Size .Iz�r7�.3..0�� f . Distance to nearest: Well ...�1..............................Foundation -----�?-a.-•---- Prop. tine .......�.�..... T REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------------ ....... Date ..................................I Septic Tank (Specify Requirements) _________________ - ...... ................"••---.......I.....----.........._. Disposal Field (Specify Requirements) ..... _---- - -. ...................... ."""...-•-"•.--... --- - - ----- - ---- -_J,�- -_� -------------------------------------------------------------•-----•-----•----•-----------•-•---------- - ..................>................................................. ........ (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 Son Joaquin Local Health:D[strict. Home owner or licen- sed agents signature certifies the following: k "I certify that in the erformance'of the work for which this permit is issued, I shall not employ any;person in such manner as to bec a subje t o Work an's pensatio taws of California." _ �- I Signed �." ... _.. $y ---- ----------------------•--• . Title ....".� k ..._.._..--- (If other than ownerl _ DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . . _.r. .. --•----- ----------------------------------- DATE ./'fa... ../-)r..7-1` BUILDINGPERMIT ISSUED ................................. •. • • ---------------------------------- DATE .......................................... iADDITIONAL COMMENTS --------------.......•-----------.."..-•----------.... -•••--.----------- .................................................... ----------------.._.._..... i 000, --- ------ -------------------------------- Final Inspection by: -•--. -___-- .Date .... . 13 21a 1-6i3 SAN JOAQUIN .LOCAL HEALTH DISTRICT 8/74 3M