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FOR OFFICE USE: =� APPLICATION FOR SANITATION PERMIT t .........................1.....---.. No. .-, (Complete in Triplicate) Permit ..... ..........I............. . ................ Date Issued .................... -------•--......... This Permit-Expires 1 Year From Date issued 4 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein i described. This application is made In compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION X_ ...a� •-_... ........:.. ............... CENSUS TRACT .,---•.:.:....:........... � _ . Owner's Name ........ .. ..G.�.451�.�'.�P..---.. .......................................•---- .... .........:.........Phone ----• ..................._.... Address ------ . -- .... Cit ........................... . Contractor's Name _ . u' / a ------. ---•-_._... .................License # 7� 1 /d. Phone ............. ; i Installation will serve: Residence partment House Commercial ❑TraIW Court 0� FMote) ❑Other ............................................ Number of living units:___.. -----Number of be ooms .-:.......Garbage Grinder . ... Lot Size 1%12�................................... ' Water Supply:,Publis System and 'name ------4V....----------------------------------------------...............•-...............................Private Character of soil to a depth of 3-feet... ` Sand❑ - Silt❑ Clay ❑ _Peat❑ Sandy Loam ❑ Clay Loam ❑ 'Hardpan ❑ Adobe ill Material f yes,type .............. i (Plot plan, showing size of lot, location ofsystem 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................................................ Liquid Depth .................. Capacity ....... .......... Type ................:' Mi aterial_......-- .........__No. Compartments �. Distance to nearest: Well` �'-_. .Foundation ..................... Prop. Line LEACHING LINT~ [ ] No. of lines �`_--:................ Length of each line............,............... Total Length ............................ r D' Box Type Filter Material ---------Depth Filter Material ' Distance to nearest: Well ....... ................ Foundation ........................ Property a ....................••.. SEEPAGE PIT [ l Depth ----------"--------- Diameter ................ Number ...................._•.-.' "Rock Filled r'Yes []<, No 0 ! Water Table Depth ............................Rock-Size ---_....-...... ..............' S Distance to nea'r'est: Will ........................................Foundation ................... Prop. Line ...................... Q REPAIR/ADDITION(Prev. Sanitation Permit# ............. __. ------- .. Date .................... .......:. c[ ...] --- � Septic Tank (Specify Requirements) ................... ... ---.._ __ Disposal Field (Specify Requirements) ......... ....__il.` ...._._. °.._ 1s1�f .cv . �f ........................................._.. ----------------------.......--•-- •--......... . . . .. ................................ ----------------------------------------................•--.........-••-•--- •---•-----....... •--• ----...... ..,__..... ....------....--•--......_._... id ... (Draw existing and required addition on reverse se) I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin S County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local_Health District. Home.owner or lice 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 parson in such manner os to become subiect to Workman's Compensation laws of California." Signed ................. �.`...�_.....------------...................--- Owne��629 aY v r /' ..:. ......... . title _ ............................. f`f (if er than owner) I OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY :.:... - BUILDING PERMIT ISSUED ....................>..DATE ADDITIONAL COMMENTS .................................. 1. - ------------------------------- -------------•-_.. ... = ._.....................................v •-- - - . ...... -- ----_ I............................................... ........... ........--•---•. -••----- .............. -----••-•-- r ---•--•------------- ........................................ -----....--..... Final Inspection by: ....:...::. E. . ---- ---- `': ............... ......• ------.Date . .... . --• SAN_JOAQUIN_LOCAL HEALTH DISTRICT E. H.13 24 1.'68 Rev. 5M 71723 .14