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FO. .. R OFFICE. USE. . : ...... APPLICATION FOR SANITA`ION PERMIT Permit No: ...�3"'.�.�. I ........ ... ... . .. ........... . ......... .. . (Complete in Ykplicatel ................................... This Permit Expires 1 Year From Date Issued bate issued .. .a7.1Z. 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 � _ �- /.t' . 1 4w. .....-CENSUS TRACT Owners Name � ....... .•. Address ...................7IV 34F .-- -' � ._..................4...... City "1 i. ----------------..........y.................. Contractor's Name ................ ...........:------------------------------=--------License # ............-------..... Phone .............................. Installation will serve: Residence 2-kpartment House C3 Commercial ❑Trailer Court 0 IMotel ❑Other -------------------------------------------- Number of living units:..... ..... Number of bedrooms ............Garbage Grinder ------------ Lot Size ........--------........................... : Water Supply: Public System and name .._.. ------------•--•-•-•--•-------•------------------------- ------....Private ❑ Character of soil to a depth of 3 feet:; Sand Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loom ❑ Hardpan E] Adobe-[] Fill Material ...._.. .... If yes,type ............................ I y (Plot plan, showing size 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 [ ] SEPTIC TANK't ) Size................................................ Liquid Depth .....--------------------- r Capacity -----k........... Type -------------------- Material------------------ ... No. Compartments ...: .............. . ......_Foundation ................ _-- p . . Pro Distance-to-r-nearest. Well ____________________________ - . Line ...................... LEACHING LINE [ ] No. of Liinesl________________________ 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 ...................... I REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------- .............. Dote _........... ..................... Septic Tank {Specify'Requirements] -- .. ''....�, - Disposal Field (Specify Requirements) ____ ._._------ -------••-• { koeWv ----------------------•--.------------------------•-•--•-- �-- . .................. - I .................................................. ...... ----- -----------------•------- ••----..... . ..__..._..............-----.. .......... - -{Drow-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 licew sed agents signature certifies the following- -I allowing:"1 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 becomes b'ect Workman's pensation laws of California. Signed ,••` Owner /� .._.. By ` - - --� - - Itle _ .. .............::-. I -�-�-� (If other than owner) ' FOR EPARTMENT USE ONLY APPLICATION ACCEPTED BY .................... .....`.... `- ......---........._.._ ................. DATE . .- ---------- BUILDING PERMIT ISSUED .......................................... -------------------------DATE ------------------------------------------- i ADDITIONALCOMMENTS ...............:.!........-- .................................=-----------............ - ---------- ------------------------•---.............-----•--•-------- i __ ---------------------------------_______________________•••••••_...........................................I_--____........_..._.._.___.._.......... •• ...._..............-••-•......................... -------------------------------------------- f.. .._.. !_ .....---._---...._.__.............._............-_................................_..._. .. Final inspection by: �1 - -- M .............r.............. ........................----•-•-••--------.:_..........------•--------------...........Date ..�....._.:1._1...�...�_..._.._._... .... SAN JOAQUIN LOCAL L HEALTH DISTRICT i= u 13 24 1_-AA a.,, %An 7/72 3 M