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FbR OFFICE USE: ........................... . .. . APPLICATION FOR,SANITATION PERMIT (Complete in Triplicate) Permit No. ...:- f This Permit Erxpires 1 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 mad►e in compliance with County Ordinance No. 544 and existing Rules and Regulations: C JOB ADDRESS/LOCATION .......CENSUS TRACT Owner's Name x..._.._. -.Phone ................. ........-• --••---••................... ......... ` Address !.. ......... City ... .. I Contractor's Name ,. �' - -..._ -- - .-.License #!A- G / Phone :� . .... . 5�? �_....i . Installation will serve: Residence]Apartment House 0 Commercial ❑Trailer Court ❑ Motel ❑Other .............` ... .............. f 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 0 Peat❑ Sandy Loam {] Clay Loam C]�,. .� E i ;Hardpan [] Adobe ❑ Fill Material ............ If yes, type ...........__.............. (Plot# pian, 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• Liquid Depth ...................:...•^f l Size Capacity .. Type ----- ------------ Material................. .... No. Compartments 9 Distance to nearest: Well "k Foundation ...--- -- •--- ..... Prop. Line ... O LEACHING LINE [ ] No. of Line Length of each line_.. Length ota 'D' Bax .....' Type Filter Matend l-.-:-------.-------Depth Filter Material ...... Distance to nearest: Well -------------- ------ FoundationProperty line _--_-__-... .---.-- ......._.... SEEPAGE PIT [ ) Depth - Diameter ................ Number ------.. ._..........------ Rock Filled Yes ❑ No 0 t _ Water-Table Depth .............. .•-•-----•-----'--------•--•.....Rock Size - .---------------------------- Distance ---------•------ ----Distance to nearest: Well - ---------------------------------------Foundation -....._.... ....... Prop. Line ..-...-._._...._.. REPAIR/ADDITION(Prey. Sanitation Permit r# -------- ............. ..--_-_. Date ----._....__.____...-._______.,._.} Septic Tank (Specify Requirements) .... ...... ......... ....-.- _... s J [ /� Disposal Field (Specify Requirements) 7� ---,• - i ...- t ---- . . (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- sed agents signature certifies the following: "I certify that in,tlie performance of the work for which this permit is issued, I shall not employ any person in such manner as to become svbj`ect ,to Workman's Compensation laws of California." Signeed'_�.. ............. .....f Owner BY 1 � .'.F--.... ....._..- (If other than owner} ..• TiTle . i!/�t e .... ..... ............ ------ ........ r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ............ . .......... DATE .. ..._ ............ BUILDING PERMIT ISSUED ..............._x... ...... ... .. .......DATE . .................... ....,__._....... .._. ADDITIONAL COMMEN . ---- ... ..-- ---.....- --- ........... ------------ ►�_.. P :.-.,_i -.�6.._-..,6a�Gs .. . ------_-•-- --- --_------ . -._.. . ...._ ------------• ........... ........ ....... .----.......-..... -• .--- - - ----- ---•-----•-- ............ ,.. _ •----------------- ------ •---------------.-Dote Inspection by: SAN JOAQUIN LOCAL HEALTH DISTRICT 4 Z3 24 i E. H. 1-'68 Rev_ SM