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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .............. -••--- ............... ...... Permit No. �.s.s (Complete In Trsplica%) . .............................................. .......................... ..--............. This Permit Expires t Year from Dote Issued Hate 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 made in compliance with County Ordinance No. 549 and existing Rules and Regulations: .3 Cre , JOB ADDRESS/LO O` .........CENSUS TRACT Owner's Name .-- -- ------•------------- ...... .....................................,-....._..._,....:i, e.. .p� ...---....-•---.............._.._ Address ...F;_22 -f-� 0 ... r' %. .......... •...City . ••. ...... ... Contractor's Nome � 71-SW" " C ....... .....................License # _ b: �...._ Phone •--3 F Installation will serve: Residence pj-w�artment House Commercial OTrailer Court ❑ ; ' Motel ❑Other Number of living units:...:........ Number of bedrooms .. ._:Garbage Grinder .............. Lot Size .x2L0._..._............................ t dilater Supply: Public Syste r :and name........................ ._...Private .---.._.................... ....... ..................................... r Character of soil to a depth of 3 feet: Sand 0 . Silt 0' Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam B-1 ( .s Hardpan[3 Adobe❑ Fill Material ............ If yes,type............... ............ V,,11f (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed an 'reverse side.) NEW INSTALLATION: (No septic tank or.seepage pit permitted If public sewer is available within 200 feet,) Q PACKAGE TREATMENT ( l SEPTIC TANK f ) 4 Size................................•--••----•---... Liqu€d. Depth ......----........_._..... Capacity ---------=---------- Type -•--- ........ Material...................... No. Compartments ------ ....... b Distance to nearest: Well .....................................Foundation Prop. Line -.....____------_.-- LEACHING LINE [ J No. of Lines ...........:............ Length of each line-.--------------------------- Total Length ........._.................. 'D' Box ............ Type .filter Material ....................Depth Filter Material ........... ............................... Distance to nearest: Well ....................... Foundation Property Line ........................ SEEPAGE PIT { J Depth --------------------Diameter ---------- Number ----------._.:•._- ......... Rock I'died Yes ❑ No Water Table Depth ..Rock Size Distance to nearest: Well .Foundation .... Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit d# ._. Date ..:....................... ) SepticTank (Specify Requirements# ----...............--.......................................................��.........---•----...... ----••---•--.................. Disposal Field (Specify Requirements) ----._�--....._ f sr.._...-....,_` _..------- ..ham ----------=-=---------- .. 13 . �._.... ` ...: ' 1 here6 cert - - - ------ --- , (Draw existing and required addition on reverse side) ' ? . y certify that I have prepared this application and that the work will bo-'done its accordance with San Joaquln 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 the performance of the work for which this permit is issued, I shall net 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) r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ....... .. --_. DATE -._--- -Za- __ . ------------ --------------- -------------••-- BUILDINGPERMIT ISSUED ........................... .....................I....................... -----------------..._A---------DATE .-...._...__-._..........-----------•----- ADDITIONAL`COMME.NTS ---------- ------ ' ...................._............ ; .....,.__;.._._...., ....::. ,...._..... •------------- - -------- ---•-------- ._..._.-----•--•-------------•---- -•------•---•-----------••- --... -•-------- --------••----• ...._-------- ____________________________________________ _ - - 3 ...... Final Inspection by: ..................... -- -•-- Date .... .. _.? ' EH 13 2h 1-68 Rev. 5m SAN JOAQUIN LOCAs. HEALTH DISTRICT 8/7h 3M