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FOR OFFICE USE: � - APPLICATION .FOR SANITATION PERMIT 77_ 7?l lCempjete In_Triplicatel.. a_ a« .P _.. __, Permit No. ..................... ......:.................. ................... Date Issued ....---.-•----...... This Permit Expires 1 Year From HateIssued . ��`99ga Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work in described. This application is made in compliance with County Ordinance No. 549 and existing Rules and RegulQti JOB ADDRESS/LOCATION ....__.5: . ........ ! .-•-- .. 1.,�?. 1 ...CENSUS TRACT .......................... !� Tg23 .. O O Owner's Name .if-- .......... Phone ..........------- - .� .:...... :. ?. .:..:. .::..... :. . Cityw .7. '-/ 1....Address 7_.. Contractor's Nome ...... __ ----------------- ..............................License # ------ ............ Phone ..... ---•- •-••--...- Installation will serve: Residence 0 Apartment House] Commercial oTrailer Court 0 Motel 9E•ther........................:.................... .. Number of living units:-..-/... Number of bedrooms ...__Garbage Grinder ............ Lot Size ...................... ..................... � Water Supply: Public System and name ------------------------------------ .------------------- —------- -------..:_...--------------------......_.__Private 0.Character of soil to a depth of 3 feet: Sand Silt© - Clay Q Peat❑ Sandy Loam 0 Clay Loam 0 Hardpan 0 Adobe 0 Fill Material ............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 pu lic sewer is available within 200 feet,} PACKAGE TREATMENT SEPTIC TANK .......... Liquid Depth --------------------- opacity � .�:. pe _�'��... Material--------------=--•-_.. No. Compartments :...__...... . Distance to neares : Wel! .....:..............................Foundation ..._-_.._...__........ Prop. Line LEACHING LINE [ No. of lines ...... .......... Length of /./ch line-------fie. ••---- Total Lengt�r.__�-��-b...._._. D' Box -. "'.. Type Filter Material _(_T.1�- pth .Filter Material .. _Al-- -----------•-----_--._.- ;T Distance to nearest: Well ...:.................... Foundation ........................ Property Line ._____.•-•---•----.-._.. SEEPAGE PIT [ } Depth ......:-------------- Diameter ---------------- Number ............................ Rock Filled Yes (] No 0 X Water Fable Depth -•..............................................Rock Size ................................ Distance to nearest: Well -_----------- .Foundation .................... Prop. Line ---------------------- y REPAIR/ADDITION(Prev. Sanitation Permit# - -- ........ Date 1 SepticTank #Specify Requirements) .......... ...... ................. :............................................................................... ....... Disposal Field (Specify Requirements} ------------ .... ...........--•- •-- --•--- (Draw existing and required addition on reverse side) - I 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:. "1 certify thatethnperformance of the work for whichthis permit is issued, iI shall not employ any person in such manner as to become to Wo on's C$pmpensation a sof CaliforniaSignedX----- �l...l ._ 'Owner BY -----------------------------------------------.......•...................=-------------................ Title ----------------- -•---•------.....----•- -------------- ........ (If other than owner) FOR DEPARTME T USE ONLY APPLICATION ACCEPTED -------- ---� -------- ........ .........:................,DATE ..._._ .. .. .�_. = BUILDING PERMIT ISSUED ...-_------_---- ...................----••----------._... .---------------- ...... DATE ADDITIONALCOMMENTS __...__... ...................... --- -- -----.-- ............................'.---:...------......---...-------------• _..__..._.. ........................ i ---------- •------•---------------------"- ... .............................. ---...._._...------ •-• - -- '..................__... .................................... Final Inspection b - -------- ---- ------• ---- •--------••-Date ... �..�i�� • P -- -- ----- EH 13 2h 1-66 &-v. 5H SAN JOAQUIN L CAL HEALTH DISTRICT B�7 3M