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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT `` ..... " .. . JS S .... ...................... . (Complete in Triplicate) � Date Issued .....-.. ......... 4- . . . .. ...................... .....:.......•.--............,.:.. This Permit Expiresfl Year From 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 made in compliance with County Ordinance No. 549 and existing Rules and Regulations; pp g� JOB ADDRESS/LOCATION ............. _..-_. ..........CENSUS TRACT ............__......... Owner's Name ........ -... M...�9 'P .._...... :.......... .. .........Phone _ '. 7t� ..... # �, � Address �2L. t G" . %�! 'City .-...._.... _.._._..._... ... t .. Contractor's Name ... ... . :_. ..-- ..:.c... / :_.license # aS ;�fs..... Phone . ?4-', 0"�..... Installation will serve: Residence j]Apartment House,] Commercial MTrailer Court 0 Motel ❑ Other -- >• , Number of living units....,. . Number of bedrooms '""f Garbage Gri de i `Lot Size b 'X L v . .� Water Supply: Public System a d name .............. ...... .:_ ... �: " , I .....Private (] ....- ~*, i Character of soil to a depth of 3 feet: Sand Silt❑ Cloys[] Peat[Q Sandy Loam []. Clay Loom_ t Hardpan F-1 Adobe ❑ Fill Material . ..._... If yes, type ....... ..._....._.. 1 (Plot plan, showing size of,location of system in relation fo.wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is avoilcibie within 200 feet°) l PACKAGE TREATMENT [ ) SEPTIC TANK f ) Size.-. .-------- Liquid Depth ......................... capacity ...... .: Type ...-.No. Compartments .... .... ...... Distance to near'es ZZWeli - _- ... . _._ _.. .. . .....,.Foundation ...._:..... .. ...:... Prop. Line ._.:.... LEACHING LINE [ ) No. o Lines _ `.:.- Length of each-l —ine `' ` .._._. Total Length ..... ........ ..,_... } � D' Box ;... Type'Filter Material. _ epth ,Filter,Material .. ..-.._�. .. ._.. I Distance to nearest: Well ................. `Foundation _. Property Line ...._ SEEPAGE PIT [ ] Depth Diameter .- ...... : Number .. ... _ .ikf Rock Filled Yes ❑ No Q Water Table Depth ........... .. T7tRock�Size .! .ti t^- .. Distance to neatest: Well . . ..... . ....::._ -- -.,-Foundation a..... Prop. line ....................... ON(Prev. Sanitation Permit# ---. �_._..._ Date _ _... REPAIR/ADDITION f _�y ._ _L_ i Septic Tank (Specify Requirements) ._._... l � r .... ....� - "-------- - ! 1._ Disposal Field (Specify Requirements) .- __q ...... ..... ......... .. ............ ----- ... ._. .... ................................ (Draw existing and'required addition on,re a se side) I hereby certify that I have prepared this application and that the work will be done in aaordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin'Loca) Health District. Home owner or licen- sed agents signature certifies the following: s "I certify that in the performance of the work far which this permit is issued, I shall not employ any peirson in such manner as to become subject to Workman's Compensation laws of California.'° + Signed ......... ....... .... ....... - . Owner ) By .._: .. . . - c.... ..,. Title (If oth an owner) i FOR PARTMENT USE ONLY APPLICATION ACCEPTED BY ... .._..... . .._ c.. . ........:....._ _ ..: ._ ,.-...... ......... DATE ....:�J..:, BUILDING PERMIT ISSUED ... ..-j.. -- . ......... .... .. .. DATE ........ ....... ADDITIONAL COMMENTS ...................... ........................................................... _...._ ......... ......... ......... '. .---- ...........------------- --•..................... - --` ---. _.-...__........... ... ..... ... .. :... ..........-----......._. ------ Final Inspection by: ...... ---_-:_. Date ... ... ......................... SAN JOA IN'LOCAL HEALTH_DISTRICT c u 13 24 1_ ,cn D_ KAA 7172 3 L11