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ICOR OFFICE USE. -S • .r APPLICATION FOR SANITATION PERMIT �j (Complete In Triplicate) Permit Na. 7�-. "1 S . .... .......... .4...�....�.�._. ..... ...1...._ ThIs Pennit Expires 1 Year From.Date Issued ate Issued .T`....._._.-...-- 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 a in compliance with County Ordinance No. 549 and existing Rules and Regulations, JOB ADDRESS/LOCATION ..._-.. .... .... --• ...........CENSUS TRACT �� .// Owner's Name ... ..:. .......... ........... s7 � `4 ...................P one . ..... Address . '-- ------------ --------------- City ................_........................ Contractor's Name __/_0_i,_ ...__.. ...............License #,.,;!4`VJY__._. Phone _44 Installation will serve: Residence 19 Apartment House 0 Commercial OTraller Court 0 Motel ❑Other ............................................ Number of living units .. : -____... Number of bedrooms ...7�Garbage Grinder ____._ ..,.,_-/Lot Size 40�_ __ k............. r Water Supply: Public System and name ...................•................I............-...-.._�.-_--- 1A.� - ..........Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay .0 Peat❑ ndy Loam ❑ Clay Loam 0 � Hardpan ❑ Adobe 0 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,) PACKAGE TREATMENT { ]„ SEPTIC TANK _] Size----_----__--: ............................. Liquid Depth ------------.--.----_----� Capacity -------------------- Type .............. Material_._......------------- No. Compartments Distance to nearest: Well ____••..............................Foundation ----.------------..... Prop. Line --_-----------..---.5 LEACHING LINT: [ J No.ry61`1nes ..-_------------------ Length of each fine----------------------- ..... Total Length .....___................ V.-Bcx A .-_... Type Filter Material __......._..t.._ ..Depth Filter Material a v} Distance to .nearest: Well ........................ Foundation -._..................... Property Line ................. ' SEEPAGE PIT { J Depth .................... Diameter-----------•..... Number ..-- _-_--.----.- Rock Filled Yes ❑ No i❑ I r Water Table Depth Rock Size r, Distance to nearest: Well =----.......................Foundation ................. Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# . ....... Dat .......� •-••--. -------�..................... Septic Tank (Specify Requirements) .... r. _ ?yl._ ........................ ................. Disposal Field (Specify Requirements) r l ......................... '" 4 _ ti 'l !� y -----•-------------Q =----- ---i-- -----------......... . - {Drow-existinu-and-requiied-addition on reverse...................................................................:..... -----------------------•---•-•----•---------- ... side} I�hereby certify that 1 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. Nome owner or licen- sed agents signature certifies the following: "I certify that in the performance of the wor for which this permit is Issued, I shall not employ any person in such manner as to become sub'ect t arkman's Compen otion laws of lifornia." f Signed .. `"`a ... -- .......... ......................... Ovmer BY Title . _._ �_ "" Ilf other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - --__--. DATE .- -"'l-j'� ------ BUILDINGPERMIT ISSUED ------------•---- -------------•............... --------------------------------------------DATE ------------• -------------------------- AODITIONALCOMMENTS .......................................... ............. ........:.:..........•-----------.._....._.... ............................................. �_ ...--.------.......----- •------- ----------------------- ----- ------ - ---.. _. .. Final Inspection by: ---- t - ------------ --------.Date .. "` :� ...._.....---• 13 2{i —6 �'�• SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3N1