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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. .-- (Complete in Triplicate) .................................... ' Date Issued .....:. .....:.................... This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and 'install the work herein described. This application is made in compliance with County Ordinance No. 54 an exist i g Rules and Regulations- ' egulations: Ja .-z2 '12 ....:. . .... .........CENSUS TRACT .......................... JOB ADDRESS/LO ON , -�.... _-. i o Owner's Name ... .................... •. • --••--....-•-•••...._...........-----.............---------....... ........_....._.._.. . �j_ Phone ........---- Address .791r,> 4- -----.-Ak --• _..-- ......-, City .1 ._ ................................ ............ .... U. c ..:... License # �� ,... y . Phone .... Contractor's Name ....... . ` Installation will serve: Residence (Apartment House-❑ Commercial ❑Trailer Court Motel ❑Other ............... •-------------_------_---- Number of living units:.--- ... Number of bedrooms ..... ;...Garbage Grinder ------------ Lot Size ......................:.................... . Water Supply: Public-System and name ....................................-----_----•----•--........... -----••-•-•---•-• �4oy_Lci`arn .... ... ..Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peot❑ Sandy Loam ❑ p Hardpan ❑" Adobe o Fill Material ............ If yes,type --.....----_-----_------- (Plot pian, showing size of lot, location ofsystem in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: _ (No septic tank'or seepage pit permi"ed if public sewer is available with in_2Q feet,),,, PACKAGE TREATMENT [ ) SEPTIC TANK t,l Size................. ................. Liquid Depth ........................_.X CapacityType ... Material...................... No. Compartments ................. 0 ..Foundation Pro Line Distance to�'riet�rest• Well ..._. ..--•---• -------------------- p• ....:................. z I LEACHING LINE [ j No. of Lines -------------_- .... Length of each line---------_-----_-----_--_ Total Length ' 'D' Box ............ Type Filter Material....................Depth Filter Material ....---......--........... ............. Distance to nearest: Well _7-=.......... Foundation .....'.."""'•Property Line- -------.---- SEEPAGE PIT [ ) Depth ------------------ Diameter .............-._ Number ............................ Rock Filled Yes ❑ No il - Water Table Depth -------.--_----_------ ..................... Rock Size Distance.ta nearest: Well ..........,-----------------•------------Foundation .................... Prop. Line --_-------------•--- -0 REPAIR/ADDITION(Prev. Sanitation Permit# ......:..................................... Date .................................. Septic Tank (Specify Requirements) _------- ......... ...................................:......................._... ..... ............ Disposal Field {Specify Requirements} t .._f`Z�.. ' '' '''t'••-�'�.............' ' Q` •.•----------------- n�7 .._. --- ------ ---- ---- - ---- .X....J.p == (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•, E 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 d By ...............................................................---........... ii-f -` 'd" Title .... e�--� �N. ��. (If other than owner) `- FOR DEPARTMENT USE ONLY \' APPLICATION ACCEPTED BY .-- DATE ..... ..^ 2- . .... BUILDING PERMIT ISSUED ......DATE ADDITIONALCOMMENTS ............... ........................ .................................................:................I.......... ...............................................................j....................................-_••-------........................................... .......... -.. ............... .... ... .--........• D ... Final Inspection by: ...... ......... ... ..... a t e -.. SAN JOAQUIN LOCAL HEALTH DISTRICT 13 24 1_-Aa Qp.. Slut 7/72 3,211