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FOR OFFICE USE: -------I- ------ APPLICATION"FOR SANITATION PERMIT (Complete in Triplicate) Permit Nq/ --.._S. ' Date Issued .../....... _ .......... ................................... This permit Expires 1 Year From Onto 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} i h compliance wCounty Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ./``.�.iJ(). .. --... ......................CENSUS TRACT ......................... .... Owner's Name y u.!tet. - - ...Phone . Address ....... ...... •--••--- -�...._-•. - � -- •............ . . . ......... . ... ... ....... City ....,............ . Contractor's Name ........................License # ........................ Phone .............................. Installation will serve: Residence tKApartment House Commercial ❑Trailer Court ❑ `� -- Motel ❑Other ----,--J--•------------•........ ........... Number of living units: _ Number of bedrooms •_=J---__--Garbage Grinder �Lot Size -.-5 Water Supply: Public System and name --•---•-•--•--- -----•............................................_..........................................Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Cloy Q Peat❑ Sandy Loam 0 Clay Loam ❑ HardpanJ5 Adobe'' 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 pubic sewer is avoi ble within 240 fest,) ff``1 / PACKAGE TREATMENT ( ] SEPTICTANK S-ize Liquid Depth ... ............- Capacit� G._. Type�rP Md#eridl ......-0--------.-- / Distance to nearest: Well _�{d __`...............Foundation Z d--........... Prop. Line LEACHING LINE Na. of lines ... ................. Length of e li 0_____._.__.__. Total Len thQ .......,. .......... 'D' Sox .__ Type Filter Materia............. ......Depth Filter Material J. ...r..._.•------.._................ Distance to nearest: Well _. Foundation ........ Property Line .vZOdP........ SEEPAGE PIT, Depth __!2S_1-------- Diameter J_ _'fl_- Number ------ _________________ Rock Filled Yes No Water Table Depth .....................------. ----•- -----.......Rock Size •-•--•-2-"i. /•--- Distance to nearest: Well ........................................Foundation .......... Prop. Line ......,............... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ................................... Septic Tank (Specify Requirements) Disposal Field (Specify Requirements) ------------------------------------------ ............. ---._.._....----...-----....----....-•----......__...-••---....._.__........ ------------------------------------ ------•-----•- .................--••---------------------------- ........................ (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 San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify thpt in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to bec sub" 4c t man's Compensation laws of California." Signed -- ---------- ------ - --- --- - y-'-•------------------------------------ Owner By ----------------------••----- - --- ----.----------------• xitle ... (if other than owner) ALL FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY _. .. ..--._-, DATE . . . BUILDING PERMIT =SSI! ------ ------ ..................DATE ------- --------•_........-----• _._.. ADDITIONAL COMM `� ��._ -----.--••-•-- $' ._� :_4 t .l ---cam ----------------------------------- ---•- . -•---- ----------------------••-........................... . ------- �.._..... FinalInspection by: ............. ----••-•-----------------------------------.............._.---------- -----•• . ----........_.......Date _..� . .- -. ..7,5.-------------- EH 13 24 1-68 Rev, 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M