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FOR OFFICE USE: APPLICATION AOR SANITATION PERMIT ' (Complete in Triplicate) Permit No. ...................... a........................ This Permit Expires I Year From Date Issued Date Issued l. 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 compliance with County Ordinance No. 549 and existing Rules and Regulations.- JOB egulations:JOB ADDRESS/LOCATION ......... _ .T._...1"4.�M. .IBJ. ........................:.........CENSUS TRACT ..................... Owner's Name --- ---•--. !� !,...._�C 4 .4... . '-..�c-�-------., - ----------------------=-•---::..-----.._....Phone ................................... Address .. ..._ SAt -. City ----------------------------------------------- ........... Contractor's Name b,..A____ t ......license # c -� °3. PhoneF-�_ ; ... Installation will serve: Residence OkApartment House Commercial '❑Trailer Court fl , j Motel ❑Other ................... ................t ---- Number of living units:------ Number of bedrooms .4.....Garbage Grinder ............ Lot Size -_. ......... ? Water Supply:jPublic System and name ----------------------------------------------------------.....................................1.7.................Private ❑ Character of soil to a depth of 3 feet: Sand Silt❑ -Clay ❑ ' Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe.K 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.l NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,J PACKAGE TREATMENT [ ) SEPTIC TANK{ j Size.......................... -r-_....._.___ ... Liquid Depth ....................... I Ca acit .. Material---------------------.. No. Compartments ............ ' Distance to nearest: Well .............................:......Foundation .._. ....... Prop. Line :...:.................. e LEACHING LINE No._of Lines -----------------FLength of each line------------------------- Total Length ---•--. ......... 'D' Box -_-•-------- Type-Filter Material 7............ Filter Material ._-__...._................__.. .� pp Distance to nearest: Well ........................: Foundation ........ '._...-_.... Property Line .......................... SEEPAGE PIT , [ ) Depth` ............ ..___. Diameter ................ Number __._.._... ................. Rock Filled Yes 0 No ❑ • Water Table Depth .................. Rock Size __Founda _•-- tion .............. . Distance to'i nearest: Well/ ....-•--.------- . Prop. Line ................... REPAIR/ADDITION(Preva Sanitation Permit# Date ..........:...................... •-•- ----- ------•- J Septic Tank (Specify Requirements) --------- .: �? ..: �....al :_.. w = —�t�.:_._........ .......4. Disposal Field (Specify Requirements# -•--- $o.� 1�t_ .�....... ..._.. ----------------- �.�x Ate.` - r ... �5 -- •..................................• -•------ #... __ _.. _•--•--•----•---•- ._.___..:•--------------------------- --Draw existing , g d 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 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 tha owner) '" FOR DEPARTMENT USE NLY { APPLICATION,ACCEPTED BY .- 7. ........... ............................... DATE i BUILDING PERMIT ISSUED .................................................. ......... .DATE .................... ....... ............... ADDITIONAL COMMENTS ..............s.............................................. ...... _`.I:...__... • .. _ __ E .................. ............•-- ------------- ----7.._.......-- --•-.............----..._................-•••--...._.......................... ---- ---'.... ....... ._............._. .yd ....................................... c__._ ! Final Inspection by Date .............. 7 _ SAN JOAQUI, LOCAL HEALTH. DISTRICT F w 13 24 1--Ari P... rA 7/723 .14