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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT � �...... .... ............. �V�'` �_._. ._ n A Permit No. . ......... •....... ' 1 .... (Com e'in Triplicate) 7-e�" Date Issued ........................ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to constru�ondstall the work herein described. This application,is.made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION S��G`iC. /f7 -- ..�CkNSUS TRACT .......................... Owner's Name ...9?�r? --- S�S<6. .r �............................ Phone .................................... Address �.�'._..7. .. ... ��., . ...... /[-'b-•-_- ...Cit Contractor's Name ..W.. ..... t�U /_...icense #Z.�3.9� .._ Phone"7.W. '�ff7.J .. p Installation will serve: Residence ❑ Ap nt House,❑ Commercial ❑Trailer Court 0 � MotelOther --- -- ---- -- ------ -------------------- Number ------------------Number of living units: .. Number of bedrooms _------Garbage Grinder . .... ... _ Lot Size �..................... Water Supply: Public System and name ................:.........................................................-----------------------•..-.--------Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay X Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe g 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 permX itted if pyblicsewer i;available within 200 feet,...... eet, ` PACKAGE TREATMENT I ] SEPTIC TANK Size. /"(, �. A ....._ Liquid Depth ..` ... ......... Capacity� -Q O Type�rX...._.'' . 7Vlaterial�04._ No. Compartments .__ .._... �/ �9 r�r Distance to neatest: Well .F .- .__-._____-__-_Foundation . �?�. .. .... Prop. Line LEACHING LINE Jc� No. of Lines - . . , Length of' each_lin.. // Total Lengt _ f. .. ._ 'D' Box . 1�IType Filter DepiFilter Material .r.......---........... ..... Distance to nearest: _We I ... xundation G.. ........ Property Line _ ----------- 1..... . ' SEEPAGE PIT Depth .D1ameter .._Number _ __ Rock Filled YesK No 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) .._ . _-- f. ..... _- ...� -------- ---:. . . .--- -- ...... .. .. .. .. (Drdw 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 liven- 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 ........................ Title ...... (if other than , er) _ FOR ARTMENT USE DNLY APPLICATION ACCEPTED BY . BUILDING PERMIT ISSUED .... . . ..... ... ... ...... ...-- .-.----...__..._.. .__.. _._......-.-_. DATE _ ADDITIONAL COMMENTS .............. -------------------- ................... ... --_... _....-------- .....--• --- . - ----- ..................... Final Inspection. .. �... .._.__... . .. . .......... ............. ........ ...... . ....... ___J by: .,.. ............... ......................:...-�.!`_..... Date ... .. ._ .. . ._.. . ._------------- i SAN JOAQUIN LOCAL HEALTH DISTRICT E24 �-- E..F�. 13_- i-'68 Rev. SM -- -- — _. _._.._ -_ -• _.:,_ . T./.z2,3�K - -�.. ..