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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT _ _ [Complete In Triplicate) . •..... ..-•--•----- Permit No ........................................... .. . �17 Z' 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 construd and Install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations; i JOB A©DRESS/LC►CATION - .3Q.- CENSUS TRACT .... Owner's Name ...... --54i-rlo -- � •Q !y'.. .. .... .... ............. . .......... ....... Address X730. _..11�¢r� 'f r ff. ..... one Contractor's Name .. � ......... ...License Phone 'Q � Installation will serve: Residence Apartment House Commercial oTrailer Court ' Motel l]Other .._ ......_._ ' �� Number of living units,.---/----- Number of Brooms._� -..__Garbage Grinder ............ Lot SizeS. }--•-- Water Supply: Public System and name ..-• - �•-�t?.P�-� . Cla ❑ ❑ y ❑ Peat Q Sandy Loom ❑ Clay Loam ❑ "we Hardpan Q Adobe Fill Mcterial type- ..._........ If yes, a ............... (Prot plan, showing size of lot, location of system in relation to wells, .buildings, etc. must be placed on reverse side.) F NEW INSTALLATION: (No septic tank or seepage pit permitted If public-sewer.is available within 200 feet,) PACKAGE TREATMENT { ] SEPTIC TAMC J .—Size.. --•--------------------- :._..........__..._. Liquid Depth .. .Y Capacity __=- - Type -•-----------•------ Material............... _. No. Compartments Distance to nearest. Well . ' •---•--•----•. ....:.Foundation Prop. Line .................... . LEACHING LINE -� -' �-- - - ° [ ) No. of Lines --------.--•---- ---- Length of each line.._..._-=;:t.--I ` ---....._.. Total Length ........................ t. :. q 'D' Box -----..----- Type Filter Material ....................Depth .Filter Material ............................ Distance to nearest: Well _:.__.....................__ Foundation ...---.. ._-•- ... Property Line SEEPAGE PIT { l Depth "� s - Diameter ----------_--- Number .......... .....�..._.._.._ Rock Filled Yes ❑ No I" ; Water Table Depth �~^ �-~-, _- - �- - '` I E -- ---•---- ..nRock Size ....:.. ...................... Distance to nearest: Well ... .....`•---- Foundation ..._ ............... Prop. Line .............. REPAIR/ADDITION(Prev. Sanitation Permit# ......._._..---------------•------..- .-_ Date ------.. ----_ Septic Tank (Specify Requirements).___:------------------_-------- -- < 4 ............ ....... ............... .......... --------- ---------- ............. C Disposal Field (Specify Requirementsi ti E fr - w existing a nd required addition on reverse side) 1 hereby certify-that.l,have prepared this,application and..that the work.will :Ibe...clone in_accordance with.San Joaquin County Ordinances, State Laws, and Rules-and.Regulations of the.Son Joaquin,Local Health.,District. Home owner or licew 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 9 as to beco subject to Workman's Compensation laws of California." r Signed --- -- ..__...__ Owner BY - o ---.... - - . -- - --••--------- ------ Title (if other an o nerl --�._..----•............................ EPART ENT USE ONLY APPLICATION ,ACCEPTED BY --_ BUILDING PERMIT ISSUED"..------- -- - ------------.. . ......... ADDITIONAL CONtMEN.T5 ----- �---------�......... .... . .• � •---------•----•----------._..-------- . ..---------••--- •--------- . --------- -- ----- ------- ------------- - -..... } •---••-----•----..._........ ................................................ Final EH 1 In 2 ection by:� ............... 3 1-6t3 Rev' 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/71; 3M