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FOR OFFICE USE: APPLICATION FOR SANITATION PERMITS C�3� Permit No. ................... i (Complete in Triplicate) :........................................................ ........ This Permit Expires f Year From Date Issued Date Issued . -2�:.Z 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,2v // .-_(L24. _ .._ ..........CENSUS TRACT .......................... �� . .�.: Owner's��N��ame_. . . . . . .../��.... .. - -•--•----•--•------•---•--------r---...--- ._.. ....Phone � ........ Address F6), - �Q ......._...-•••-----••••-•--•---•-•...........--•--- .... City�T . ....... ... Contractor's Name .....License # ........................ Phone .............................. Installation will serve: Residence D4(partment Housei"] Commercial '❑Trailer Court 0 Motel ❑Other .--•--- -•---- Number of living units:....-/... Number of bedrooms _ .... Grinder ....°"-_..- Lot Size lj-_xz Z.0 e4. .............. Water Supply: Public System and name -------------------------•------••---•-•---•--•...------•---•--•--•-••--•--•----._.._...•---- ........Private Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ 5andy Loam ❑ Clay Loam n Hardpano 1 Adobe ill 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 o fie seepage pit permitted if public e s v Iable within 200 feet,) s. - - }"' �l ,p PACKAGE TREATMENT [ SEPTIC-TANKJ4 Siz .• `f�Fpl j.. Liquid Depth ..... .. .. ........... q0 . e !P .. aterial�C ... No. Compartments Capacity/X61-0...... Typ '. d Distance to nearest: Well ----.._1..V.. Foundation a Prop. Line f LEACHING LINE � No. of Lines ------3._____-- Lengt of each line. ........ Total Length ....,rZ. . Box'D ' -. -----_-- Type Filter Moteri dj . alS-- -------•----._. e h Filter Material ---------Z5..........................•• y� Distance to nearest Well :... .:._ Foundation /__C?.9 ... Property line .....'........... SEEPAGE PIT [ ] �Depth �::.. Diameter ....•............ Number -----.....:................. Rock Filled Yes ❑ No Q j Water Table Depth .../VioRock 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 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: 01I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become sub' c o Workman's Compensation laws of California." Signed - ----•- . • •------.O.O.:.;�•......... ..?. ...................... Owner .__..._..B ...... :..... ...._ _. .................. --•---- ........................ Title ..------.._........... ._....__..__..._..._..._.............._....... (If other than owner) FO E RTMENT USE ON Y w4APPLICATION ACCEPTED BY --- ._._.. 12 ......... DATE .r� If BUILDING PER ISSUED ------------------ •--DATE .......................................... COMMENTS`....:........... -- _.......... .._........-- -- . ------------------------------------------------ .......... ........................ . ....•----........... .................................................. .................-.........6............. �..... .. .......... Final inspection by: ....:.. ................................................Date . SAN JOAQUIN LOCAL HEALTH DISTRICT u, r r� E. H.1.3 241268 Rev. 5M 7/723114