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FOR OFFICE USE: 2- APPLICATION FOR SANITATION PERMIT ------------------------------- (Complete in Triplicate) Permit No. .�. _=/Q: 3 __-__-___-________-________ ---------------------- 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 and install the work herein described. This.application..is�-miade°•irr,corrfPI4 'th Coun y Ordinance No. 549 and existing Rules and Regulations: CATIO * ___CENSUS TRACT __.___..____.._ ------ ,JOB YtAr^Da-DRESS/LO --- r --r= ------- ------ ------------ -S--1°16 Address ------------ c3D --_C�ASS�N �`C� . CityfZAGK ,�, _ Contractor's Name --- =�`^/ ✓ S / .S ` Phone -�� 2? _ License #77-7--l-7 Installation will serve: Residence ['Apartment House❑ Commercial ❑Trailer Court i❑ Motel ❑Other ------------------------------------------ Number of living units:___- ----- Number of bedrooms -,_/___-___Garbage Grinder _177'"---- Lot Size _ _ _'�_�. .�_-____------------- Water Supply: Public System and name ----------------� --------------------------------------------------------- -----------------Private ElCharacter of soil to a depth of 3 feet: Sand❑ Silt Gay ❑ Peat❑ Sandy Loam ❑ Clay Loam fft - 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 pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [I]-- SEPTIC TANK[ ] Size------'r" .'�_'C_5_� ------------------ Liquid Depth ¢- ________________ Capacity _J:^/Type __ *i.a r Material__ No. Compartments Q............. Distance to nearest: Well _____ ____________________________Foundation _��_______-_-__-___ Prop. Line _`...�_.._........._ LEACHING LINE ti�'" No. of Lines --/-.------------------- Length of each line---k_0------------------- Total Length Z�'.__'.._..._.._._..._. 'D' BoxGW---- Type Filter Material -------Depth Filter Material ___C _ �------- ---------------_------ Distance - -Distance to nearest: Well ------------------------ Foundation ____________________ Property Line ........................ 0 " SEEPAGE PIT [ ] Depth _ Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No i❑ Water Table Depth ------------------------------------------------Rock Size ---------------------------- 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: "1 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 --- - _ - -------- ---------------------------------------------------- Owner BY -------- ---------- - ------------------------------------------------------- Title ------- --------------------------------------------------------------- (If other than ow, er) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------------------------------------------------------ D E Ion-'Sr------------------------ BUILDINGPERMIT ISSUED ---------------------------------- ------------------------------------ -------- . -------------- TE ------------- ----------------------------- --- ADDITIONALCOMMENTS ---------------- ------------------------------------------- -------- ----------------------------------- ------------------------------------- --------------- ---------------------- ------------------------------------------------------------------------------------------------------- ---- - ---------------- � ------ FinalInspectionbY� ---------------------------------------------------------------- --------------------------- - - - ------.Date � � SAN JOAQUIN LOCAL HEALTH DI I T E. H. 9 1-'68 Rev. 5M