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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT :......... ........................... ------------------ Permit No. ... . ..._ (Complete in Triplicate) L....................... This Permit Expires i Year From Date Issued --•-...._ Date Issued .... ..7. Application is hereby made to the Son Joaquin Local Health,District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: 3 .CENSUS TRACT JOB ADDRE55/LOCATlO�_..�-�-�•�--,._... .�. ........ °-�rc.�............ --._.__..-- .......... Owner's Name ...... L. - ------- - �•,------•- •-----1•--•---..._..; ��. .... ..Phone Address _ ........ .� �c ......... City ................. ...................... ......... . - ••• Contractor's Name .. `� Ee. ;- ----•r - '�'�`'' _.._.Licenseht1 r�� .-. Phone .. - ..t} i Installation will serve: Residence 09 Apartment House❑ Commercial ❑Trailer Court 0 Motel ❑ Other ............................................ t �y Number of living units:.... Number of be�oms ... Garbage Gr ndet `-lot Size .....rG?-rl._..X1....� ...... Water Supply: Public System and n me ...... .:................... ....... '? .4c' F .................................................Private ❑ Character of soil to a depth of 3 feet Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Cloy Loam Hardpan ❑ 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 fiternoitted if public sewer is available within 200 feet,) pp_ .� PACKAGE TREATMENT [ } SEPTIC TANK ] C.5 Size6............................................. Liquid Depth .......................... ` Capacity •- I---------------- Type -------------------- Material..--------------------- No. Compartments ...................... E Distance to nearest: Well ....................................Foundation ...................... Prop. Line ...._................_ . LEACHING LINE No. of Lines _._�---------------- Length of each line-.-- -C X . . LEACHING Total Length ._ `..�__.........._.� 'D' Box ---- Type Filter Material ./P ... Depth Filter Materia! . ........ � t , Distance to nearest: Well - _W :.(Foundation ----1a.............. Property Line .... ... .`. F SEEPAGE PIT (J Depth � - Diameter ..:.... Number ...../................. Rock Filled Yes Cj( No i❑I • Water Table Depth -•--••. -------------------=----- ------..Rock Size ....:.;!................._..... Distance to nearest: Well .___. ... :c _...__Foundation ....e.0 Prop. Line ... _......_.. , REPAIR/ADDITION(Prev. Sanitation Permit 94 Date ...:................I............. ) Septic Tank (Specify Requirements) ..................... iJ ...................................... t..�.�.. ......_.......-•---.•� Disposal Field (Specify Requirements[ .L� C-- . e?!��- + ---------------------- -/-------------i`?` .................. ....................................---• ._.. ------------ ----•----- ......................... ...............................- ------ t (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 liven- ', 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 Workman's Compensation laws of California." Signed -------------- ...............•• ...By .. Owner ----------•• Title ------.... (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . _..... ._ _ ................................................... DATE .... - LJ BUILDING PERMIT ISSUED . ... =` ------•-------------••----•--•- -------------DATE ........................................... ADDITIONAL COMMENTS .....:........•------..._._._.------ - ._..._.. = -----------------------------------•-•---.......-•...... .. ..-•-•----.....---•----._......._...._..._............................................................-........ ..........................I.......... ............................. ... .. ------ Final Inspection by: ... ............Date --8n�� r .............. .............. -•--•---....--•- . SAN JOAQUIN LOCAL HEALTH DISTRICT E- 14 13 241-'AA RPv- 5M 7/723M