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FOR OFFICE USE: .. APPLICATION FOR SANITATION PERMIT 3 (Complete in Triplicate) Permit No. .. til• -.__• ................................ . ...................... k , This Permit Expires I Year From Dote Issued Date Issued Application is hereby made to the San Joaquin Local Health District far a permit to construct and install the work he described. This applic tion 's mode" compliance with County Ordinance No. 549 and existing Rules and, egulat Regulations: 'T JOB ADDRESS/OCATIOIV ...-- .. _. ... -- ��-U]-�- ----------..........CENSUS TRACT Owner's Name . _.... _J.e�. Y.P�t._V.P2. .. ............ . . �.•. :..._._...:....._.... -•- - . ----- .... Address ._.._..�--•--__�/O� !�G City4` __ __.......P Phone .............• --................_.. ho �� : Contractor's Name ......... License # ....---------------- --.. Phone ...... ... ........ ............... Installation will serve: Residence . partment House 0 Commercial oTrailer Court 0 !--Motel ❑Other ................. Number of living units:..........:. Number..of.bedrooms ..........:.Garbage Grinder ------------ Lot Size .•..._____._._..._____.._ - . -•............. Water Supply: Public System and name ___...........__........._..........__ -----------------.....•---•-....-._Private 0_ i Character of soil to a depth of 3 feet: Sand Silt ID -Clay [] Peat❑ Sandy Loam ❑ Clay Loam [] Hardpan Adobe Fill Material __----_--- If yes, type -------•-------------------• r (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 r ----------------- --------- Liquid Depth ....-...................... O Capacity = Type Material No. Compartments Distance to nearest: Well -•---•••g---••------------••---.._Foundation ..__. Prop. Line nom' LEACHING LINT: [ j Na. of Lines i......... ... .......... Len th of each line.-------------_--......... Total Length ....._.__..•_- D' Box __....._�:._ Type Filter Material ............. .......Depth Filter Material .................. ........................... Distance tonearest:.Well ---------------:f---••- Foundation ........... . : Property Line ---•---• ..... .......... SEEPAGE PIT Diameter -'.:--_---_• .. (') Depth ._..(_:-... � •---- plumber .......,... . ............. Rock Filled Yes-C] No [] Water Table-Depth .Rock Size Distance to nearest: Well ........................................Foundation _...-- ........... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# __•_____________________-------------------- Date ............... Septic Tank(Specify Requirements) I................. .................. - - -- ----------------------- --------- .......... Disposal Field (Specify Requirements) l �/ '.-�F-� X3 .....11? .................... -------------•------------•-------•-•-•-----------•---------•............................... .. ----- ----- (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 of licen- 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 �blect to Wor,�cman's�girpenration laws of California." Signed . ... ...__ . �� . .. ....................•---.....• Owner BY -----•-•--------- ---------•------•---..-----•--... ...... ...---=' ---------••--•---- Title .---- _...... (If other than owner) fi ---.:.......................................... / — FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ....... _ ......_._/.... ............. DATE ..0 —/ -? ....._.... . BUILDING PERMIT ISSUED ............... ............. .........-------I............. -- ...._....DATE ADDETIONAL COMMENTS ...................... ....__........--•---...:.-_-•- ..--•----------••----------------•- ----------- .._._....... ...........................................•-------- Final Inspection .................................... ...Date _ .. ..SA JOAQtIIN LOCAL HEALTH DISTRICT E.-H..13'-24 I-- 68Rev: SM