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APPLICATION FOR SANITATION PERMIT �,� .... ....................................... Permit No. .. � ..� 6 \ (Complete in Triplicate) �\ \ This Permit Expires 1 Your From Date Issued Date Issued ..f ........... 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: 10B ADDRESS/IOCATI �. �.�.__... � l4 ' ......................... ,. .........................................CENSUS TRACT Owner's Name .......... ./-;7.1 -? :.... .!-f ?!?..................................................... ........Phone .��.L.. .7��........... x�ddress ._ . .....................6��cP71.. � ��-..�i`:`..... ............................City ..� ............................................ ... . .. Contractor's Nome License .r- ?.... Phone •.......................... ............... ... installation will served Residence 0j Apartment House Commercial❑Troller Court ❑ Motel ❑Other............................................ Number of living units:.....1-..... Number of bedrooms ....3....Garbage Grinder ............ Lot Size .....,1.�..F-�..�:7...........� Water Supply: Public System and name .........................................................._...................................................Prhrate' Character of soil to a depth of 3 feet: Sand D Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loom ❑ - Hardpan Adobe 9 Fill Material ............ If yes,type............... ............ (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 Size.....IS--/..X. ........................ Liquid Depth .. :.f........... Capacity A .... Type .-K ... Material.... No. Compartments ..... ....... Distance to nearest: Well ........C.Y`?%....................Foundation C. .. ...... Prop. Line ^EACHING LINE No. of Lines ...... ................ Length of aach line.........;,A ........... Total Length ............ 'D' Box ............ Type Filter Material ... R....Depth Filter Material .1-f................................ m „ Distance to nearest: Well ...f..�18)............ Foundation ......L ..: ...... Property Line .. .��..... p ' `` ....... y . Rock Filled Yes No i❑ SEEPAGE PIT Depth .....�:..�...... Diameter ....�.�....... Number ......1.......... ...... Water Table Depth .---•...................•-•.....................Rock Size .� ..x..l.lk ....... Distance to nearest: Well ......./,;E.:.........................Foundation ....1 ......... Prop. Line .... ............. REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ..................................I SepticTank (Specify Requirements) ......................................... .........._................................................................_................. Disposal Field (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 Sen Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or Iicen- 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." .;.a neck Owner By ..... ....G..�- Y ......................................... Title ... ...................................................... (If th r than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ...... . . !...,..: ....:..... ............................ .................................... DATE ...... BUILDING PERMIT ISSUED ........ ...........:.:.........:..............--................. ................................DATE-.:................................. ....... ADDITIONALCOMMENTS .. .................. ...................................................................... ... .............................. .. . . .............. .................... .......................................................................... .................................................. —11221.................. Final Inspection b Date .- P Y ................ ....... F.H 13 2u 1-68 Rev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/71; 3H