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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 wit Coun y Ordinance No. 549 and existing Rules and Regulations: I JOB ADD RESS/LOCATIO J."V// ..... ....... . .......... ...... ....................................-........CENSUS TRACT ........_..... ............ 1 Owner's Name -Q7"...... F _.�.. .... Phone .... Address ...-...,r �'J. .... �..... . - • City -----------------------------------------------of - --- _. II Contractor's Name •------ - - .. .license # �f. . Phone .............................. i Installation will serve: Residence partment House-E] Commercial ❑Trailer Court 0 I Motel ❑Other .....................:...................... f Number of living units:--.... Number of bedrooms -- Garbage Grinder ............ Lot Size ......................... I Water Supply: Public System and name ...............................................................................................................Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy La6m_12K Clay Loam ❑ Hardpan ❑ Adobe [] Fill Material ............ If yes, type ............................ (Plot plan, showing size of lot, location ofsystem. 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 [ ] SEPTIC TANK( Size.. ------ ------- Liquid Depth __._� ................... �� .. Type C -~-�1 .!.--- Materia�._ cn ..--- No. Compartments _�..__....... --•.f- Distance Capacity to nearest: Well ......... _.... _.Foundation f. e t ..... Prop. Line � [ ] Lines ....._... :9-------- Length of each line------ Total Length --- '40 LEACHING LINE No. of L I JJ D' Sax . -•�__-._ 'Type Filter Material ... ..... ...:.�.Depth Filter Material ._.., ................ ....�...... ....z Distance to nearest: Well .......��....../.....: Foundation ..../.G............. Property Line ........................ SEEPAGE PIT [ j Depth .. ........ .. .:... Diameter Number __..___--_i......:........ Rock Filled Yes ❑ No Q. r Water.Table" Depth Rock Size J Distance to nearest: Well ........................................Foundation .................... Prop. Line ........... REPAIR/ADDITION(Prev. Sanitation Permit# _----.--_----_------- ------------- Date ......................••---.......) F SepticTank (Specify Requirements) ................ ••--•--•------------•- ---------•-- ----....---_-..---.:............-•---................,-•-------.............. DisposalField (Specify Requirements) ..--•--•....................:.......---.........._..----..............._................_..-•----.........._._.._......._............ ---------------------------•-----------------•----------------•------------------ ---------...------------_._._... i --- --- -- --- - - - •------------ ---. ..... (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:. I "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner I as to become subject to Workman's Compensation laws of California." Signed .. :... = .... Owner ' By ...............................................��` ;._: __ Title ... �,�v..��..........-------------- ........ . ......... (If other than owner) ? FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --.. _ . ................. ...... DATE ...lL .f7 7 BUILDINGPERMIT ISSUED ....--:............:.............:.-•-----------------------=---------------------------- - ------.DATE -----.:..............---...........---..... I ADDITIONALCOMMENTS ............................•---.........-------•---•----•---•----_,............---.._..._...-•----...........................----:...-_---- ----------- ............................................................... -------------•------------------•--------•----......------...:----...---------------...----------.........-•--------•---•--•--........... .................................... - - -------•----....••---... ........--. Final Inspection by: _..:• ...---Date ... .:� "1� .. SAN JOAQUIN LOCAL HEALTH DISTRICT r 13 24 7/793 K