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r FIR OFFICE USE: APPLICATION FOR SANITATION PERMIT o .......f.�. .. ....6.......................... Permit No.2 ,.....'.. � (Complete inTriplicate) ...�;;. .....`.'. This Permit Expires 1 Year From Date Issued 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 N . 549 and existing Rules and Regulations, JOB ADDRESS/LOCATION �0 ..... .....�. ..r... ... ........ .s�. 6.Z&SVS TRACT .. Owner's Name .... .. . . ................. ... .......... Phone .... Address ... .. .................... city .. ........... .................... Contractor's Name ... :. �., .. t. . tj.icen:e # cr�`,G'.?'/..,�1`rl Phone �z Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court C] Motel ❑Other ............................................ Number of living units:.... ... Number of be rooms ........Garbage Grinder Lot Size .. s�. ' ..1 ..••. .... Water Supply: Public System and name .. . . s`.......e,-kj�.._....................................................Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam a Hardpan ❑ Adobe 9 Fill Moterlal ............ If yes,type ............................ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) 0 NEW INSTALLATIONt (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) (� PACKAGE TREATMENT [ ] SEPTIC TANK I j 5fze........................... .......... Liquid Depth Capacity .................... Type .................... Material...................... No. Compartments ..................... Distance to nearest: Well ....................................Foundation ...................... Prop. Line ...................... LEACHING LINE W No. of lines ....., ............. Length of each line.....0:. Cf.......... Total Length ... ......... 'D' Box ...;09"Type Filter Material _.a t. ....Depth Filter Materia) ......................... ,. .. Distance to nearest: Well . .C�� Foundation ...�Q.. ........ Property. : line .�$.................... SEEPAGE PIT j Depth a2..S..:. ... Diameter Number .....41................. Rock Filled Yes a No i❑ Water Table Depth ..... ....5Z7..... ....... ...........Rock Size ...��'!.....`................. Distance to nearest: Well .. .fes ..........Foundation Z.4.r........ Prop. Line .t4.............. REPAIR/ADDITION(Prov. Sanitation'Permit# ................•...•....•..•.•....•......•. Date ..................................) Septic Tank (Specify Requirements) .................. ........ ......................................... ........ ..._................. Disposal Field (Specify Requirements) ... � f .... .. ^4 ....................... ................................ .......... r-C._........... .. .1 .... ........................................................................................................................................................................................ (Draw existing and required addition an 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 Son Joaquin Local Health District. Home owner or licen- sed agents signature certifies the followings "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 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .. ............................................................................................ DATE .........;� �...�3............... . . BUILDINGPERMIT ISSUED ....... .............................................................................................DATE ..........................:................ ADDITIONALCOMMENTS .................................................................._............................................................... ........................... .......................................................................................................................................................................................................... : :::................... . .... ..........................................................................................,..:::::::: : . ....y3.................... FinalInspection by: . .........................................................................................Date ......... ....... .......................... SAN JOAQUIN LOCAL HEALTH DISTRICT cdo E. H.13 241•'68 Rev. 5M 7/72 3 M