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FOR OfFICE USE: APPLICATION FOR SANITATION PERMIT --------------- -------------- Permit No75 . (Complete In Triplicate) This Permit Expires t Year from Doh 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 made in compliance with County Ordinance No. 549 and existing Rules and Regulationss JOB ADDRESS/LOCATi ._/....._._. �,�L9.�-.. n. ............... ......................CENSUS TRACT ......... ................ Owner's Name - - j :.....................................Phone ......... .........,............ .... Address _. _. _ 2.7 ......... City ......... ... _ c ..... Contractor's Name ------- 'r- - %-c.�----y� .c�U�`�.-..• license ... ... ,1, Phone Installation will serve: Residence partment House Commercial[]Trailer Court 0 MotelQ Other............................................ Number of living units:... Number of bedrooms ......x?:Garbage Grinder,,' .... Lot Size ...... ...... Water Supply: Public System and name ....-------•......................._------....---•--...._..........-----.....................................Private�i Character of soil to a depth of 3 feet: Sand D Silt Q Clay ❑ Peat❑ Sandy Loom ❑ Clay Loam ❑ Hardpan❑ Adobe ( Fill M6terial,,e4A...If yes,type............... ............ (Plot plan, 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 [ j SEPTIC TANK{ j Size................................................ Liquid Depth .......................... Capacity ---- ------_--- --- Type -----. ............. Material...................... No. Compartments ...................... 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 fitter Material .......................................... i�► Distance to nearest, Well ........................ Foundation ........................ Property Line ........................ SEEPAGE PIT [ J Depth -------------------- Diameter ......... Number ............................ Rock Filled Yes ❑ No 0 Water Table Depth ................................................Rock Size ................................ Distance to nearest: Well ........................................Foundation .................... Prop. line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ..................................) ........ Septic Tank (Specify Requirements) ....._._....................... Disposal Field (Specify Requirements) . --•-. . ..� -�� „�� . _�...., �.... ----------- - ------------------------`� � --------- ----- ----------•---------•---_--------------------.---•------------------•--------•---.----------.-------- ---- ------------- -•-------------------------------. .....................................................-.......... ......................................... ....................................... (Draw existing and required addition on reverse side) I hereby certify that 1 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 licee- 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 person In such manner as to become subject to Workman's Compensation laws of California." Signed ----------------- - --------------_-- --- , Owner BY ..._ -------------- ----- -------- 5✓f Title - '"? .... if h thon owner) FOR DEPARTMENT USE ONLY / APPLICATION ACCEPTED BY - ---------------- U - ---- - ......... DATE 1= = -----: BUILDING PERMIT ISSUED -- ---- --------------- - --- --- ATf ADDITIONAL COMMENTS ----. ._.. .. ...... . ./...�...- .--.. _ - ......... -- --------------------------- ------ ---------- .....--•............------... -------------------- -- - - -------- ,._. ..............--..----_-...------ ............ ------ 1 Final Inspection by: ... ..... ..............._:--.Do#e .... ._�`". :G.�. .Y........-... EH 13 24 1-68 v SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M