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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ... --...................._...-- ----•---- Permit No. (Complete in Triplicate) -- ...... This Permit Expires 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 made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .. -- --_, � :��: ................................CENSUS TRACT ....... .................. Owner's Name .. ..��.►►_++. ._ .. .. e!+! : ,J �.�"... .�=_-� ^............. -••--•........:.......... .......Phone `c ..rJ Address :.. ..'1f.�_t:Z... ...I X.. ............. .................. City . .o'este _. ,,..................................... It A Contractor's Name ._s -I& _V---_.______.License # .? 't Phone Installation will serve: Residence PKartment House❑ Commercial ❑Trailer Court C1 Motel ❑Other --------------- ------------- Q Number of living units:.__.(...... Number of bedrooms.3'alt.....Garbage Grinder _IV0__._ Lot Size .................. Water Supply: Public System and name .....-...........------------------------------------------..................................................--Private Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loom ❑ Clay Loam ❑ v Hardpan ❑ Adobe 0 Fill Material ------------ If yes,type ......_-_.._____-._.•___.._- O (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 p k�lies ewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTTj TANKT7 Size_ - moi, U , .- "' Liquid Depth ..........................N p ty yp - No. Compartments ..._Ca aci _ Type --.Material._ .--•--• Distance to nearest: Wel! --------------Foundation ...................... Prop. Line .. ..... LEACHING LINE [ ] No. of Lines ____------_------------- Length of each line............................ Total Length D' Box .. Type Filter Material -.Depth Filter Material ._V °..•...��- : ..... Distance to nearest: Well ...... ------_-------- Foundation ............:........... Property Line ._._._..... ............ SEEPAGE PIT [ ) Depth ____________________ Diameter .....__.. ...... Number ....____--.__ .............. Rock Filled Yes ❑ No i❑ • Water Table Depth ................................................Rock Size -------------- -- Diistance to nearest: Well ........................................Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# --------------------------------------- .... Date .....-..------------------------•.) Septic Tank (Specify Requirements) ....... -•-•---•-- ------••.. ....................................... .•--•--------------------'...................I......... DisposalField {Specify Requirements) ------------------------------------------------------------------------------------------------------------------------ ------- .................................. -- -- .......-................-----------------------------------------------........................----------------------------------------.._.............. (Draw existing and required addition on reverse side) 1 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 the performance of the work for which this permit is issued, I:shali not employ any person in such manner_ as to become subject to Workmmpensation laws of California." Signed �� i ......... Owner By .._..... - ...G .. ............. ................................................... Title .--- ...... ------------------------------------------------- (if other than owner) FOI DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ... .._ .._r__. . ._ .__ .. .......... DATE .... .. x.77 r...� BUILDING PERMIT ISSUED ................. -----------•-------- --•--. .............................................. ....---..DATE --•-------------------------•---------- ADDITIONAL COMMENTS .......................................................................I......... ........................................ . .... ..•....... ... .................. -.......... ........ ......... .....------ .................... .... ..... ..... -----r...... ...........__._ ........... .......................... .. ....__.....I..._......._..............- ----------------------•-------..._...._....--- Final Inspection by: .... Date _... •.. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 13 24 1.'68 Rev. 5M 7/72 3