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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ........................................ Permit Na. '� ( tai In Triplicate) _.. ........ ......•---•------......._--.--..----......... This Permit Expires I 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 made in compliance with County Ordinance No. 5.49 and existing Rules and Regulations: JOB ADDRESS/LOCATION ........ LC CENSUS TRACT -�- ............ .......................... Owner's Name -- 14 `.............................................................Phone ............ ................... Address ....................... .. ... .�,... .....City Contractor's Name __ _ .... a. ........._.. .......................License ill'1�?. i.T, .. Phone Installation will serve: Residence[impartment House Commercial OTraller Court 0 Motel ❑Other............................................ r Number of living units:---- ------ Number of bedrooms - .--- Garbage Grinde� 5..... Lot Size _47..Yeo....t............. Water Supply: Public System and name .._.(24,J+ ._ "ll.. ._r.�'5-..........................................................Private 0 Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay Peat❑ Sandy Loam ❑ Clay Loam C) Hardpan[JAdobe Fill Material ............ if yes,type............... ............ (Plot plan, showing sire 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 [ J SEPTIC TANK �Size__.!.Y,Y.�`,Y. r7 v .._._..... Liquid Depth .--- v. .....,...-- Capaci#y a"epr TYPe � " 'r- ...... Material. No. Compartments .... ........... W Distance to nearest: We#I ,1 .............Foundation Pro Line P. ............... LEACHING LINE [V—No. of Lines ....)................. Length of oath fine... ..`.........-.... Total Length 4L!?1............... �' nn .1r 'D' Box lll---.--- Type Filter Material �/1��. ....Depth Filter Material .... i .................................m Distance to nearest: Well .../ Jja........ Foundation ---..(a..�---...... Property line .�.r�^.j............. SEEPAGE PIT {�] Depth .... ' -_--_-. Diameter ........._. Number ---...1._............... Rock Filled Yes .�IIIo Water Table Depth -•-------_1/..°....----•__.._•__•_•- ..Rock Size ---�,1 _ �-..----- -- Distance to nearest: Well ,/✓ �` ..............Foundation . ..... d Prop.-Line . -- REPAIR/ADDITION(Prev. Sanitation Permit ` - Date 1 SepticTank (Specify Requirements) ...................-•.........•....................%...............•........................................................................ DisposalField (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. Hoene owner or )kelt- 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 than owner) DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---•----- ...... - - ----' DATE -- �y1 BUILDINGPERMIT ISSUED ..........................-----------------•------....._..---...-----•----...DATE .................................. ADDITIONAL COMMENTS _._---- ------ _ ---•--•• ,: _._. . [ .._.. --------------••......... ......~----- ----------... .------------------....---------...------------..._..-------- ..._.... /_'_ - - EH --------• --------------- ---------------....__--_-.----•-----..... •---•--•-- -----------...-. Final inspection by: ... :._ 1kS.,; ..._.__Date - �=-/( 13 22 1-6 JOAQUIN LOCAL HEALTH DISTRICT 8/711 3M i i