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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Com fete In Triplicate) Permit No....%....". .y P This Permit Expires 1 Year from Dote Issued Date Issued ... �.�:..7. 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 ADDRESS/LOCATION ........ 4?--��-�- ................. ................CENSUS TRACT .................. Owner's Name_.._....... _ ._.. ....... Phone Address t� ` r ^..... -. --- -- Contractor's Nome._ -•- .-_-.. ,_:. ... ... .....z._'.License #%. .... Phone .............................. Installation will serve: Residen ❑ Apartmen"juse0 Commercial ❑Trailer Court a Motel E] Other , Number of living units.-.. ... ..... Number of bedrooms ........... Garbage Gander ............ Lot Size ................._......-.. ................ Water Supply: Public System and name ................e, 44 - --- .•�zt� 0 ..._ ..................................•----..-.....-.Private ❑ �. Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat ❑ Sandy Loam 0 day Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ............ If yes, type ........................... {Plot pian, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.] NEIN INSTALLATION: {No septic tank or seepage pit permitted if public sewer is available within 204 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK I j Size ...................................... .......... Liquid Depth ..........................� Capacity ..... ------ Type ............. Material ...................... No. Compartments Distance to nearest: Well ....................................Foundation ...................... Prop. Line ...................... LEACHING LINE (] No. of Lines ........................ Length of each line ...................... ....... Total length ............................ 'D' Box ............ Type Filter Material ....................Depth Filter Material ............................................ Distance to nearest: Well ........................ Foundation Property Line ........................ SEEPAGE PIT [ ] Depth .................... Diameter _-.---_-__..._-. Number .__.-.-_.---_--_---.------ Rock Filled Yes ❑ No ❑ Water Table Depth .............................. .................. Rock Size --.............................. Distance to nearest: Well ........................................Foundation-------------- Prop. Line ...................... REPAIR/ADDITION (Prev. Sanitation Permit --------------------------------- .......... Date ................. ........... ....... ] Septic Tank {Specify Requirements) ---:...... •-------•.........................................................................I.........I—— ............ Disposal Field (Specify Requirements) f� c�.,_ .�i� _ a..�,.,,•.---..._... .. v f� , ..X_ --............... :.................... -......... ............... ............ ................................ . .•-------------------- �. (Draw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will be done in accordance with San JoaquiA County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health.Dishict. Horne owner or (Icon• sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person In such manner as to become subject to Workman's Compensation laws of California." Signed ---- --------------------- --------------- ------ --- -- Owner By............ _...................----...........'.._ ... . itle. {If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ... if �3..... ..-----•---•----------- -•-- DATE S.. Z�..�.�.........._....: BUILDINGPERMIT ISSUED .............. --• ...........----•--•-•--.............------------•---------*....... DATE ..........._-...._............_.._.._...... ADDITIONAL COMMENTS ........ - ............... ................. .......... _..-------- ----.....••---------------------- ....... ...---------........................ ._....--......------.................... -------------- ._............_. ----.-....-•--------....-....---------.....-------------------.-.--------------------------...- Final Inspection by:.C�-----•-- ---------- -- ----.... .-----.........._..................... Date f Z...%_ ........__... . EH �3 2b 1-68 ltev• � SAN JOAQUtN LOCAL HEALTH DISTRICT 874 3M