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FOR OFFICE USE: APPLICATION ICOR SANITATION PERMIT ............................. ....... ............... '7 (Complete In Triplicate) Permit No. ......:....... 7 ..... This Permit Expires 1 Year From Date Issued . Date .. 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/LT10 z ....f-� o�`c.��-�.•} ...... -.,...,........ ......................CENSUS TRACT .......................... Owner's Name .. ..- .. . ........ .. .........:....................... ....:................Phon e ......... ...... .._........--•--- Address ?.2.^ .... +ti .... Ci ........ .. . Contractor's Name -.... -.:_ . C -:-..._...License # c . F.v Phone Installation will serve: Residence [3 Apartment House] Commercial ❑Trailer Court CJ ' Motel ❑Other Number of living-units:__-:1=.7Number of bedrooms _ ..__.Garbage Grinder ............ Lot Size �or� ----- ------ Water Supply: Public System and name .............. ....Private Character of soil to a depth of 3.feet: Sand b. Silt❑ Clay ❑ Peat❑ Sandy Loom Clay Loam ❑ Hardpan 0 Adobe l] 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.I NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK Ij Size.................................. . .... Liquid Depth ..................... � Capacity .................... Type -------------------- Material...................... No. Compartments Distance to nearest: Well ....................................Foundation .................. Prop. Line ...................... LEACHING LINE [ No. of Lines ------------------------ Length of each line............................- Total Length ............................� 'D' Box ........---- Type .Filter Material ....................Depth Filter Material .....:-....................................... Distance to nearest: Well................... Foundation ........................ Property Line ........ SEEPAGE PIT { ] Depth -•----------• -.. ------ Diameter ................ Number ......................... Rock filled Yes Q 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 (Sped Requirements) �.- •----•_-•-- irrr � .. (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 accordant* 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 shall not employ any person in such manner as to become subject to War n's Compensation laws of California." Signed ---------------------•------- -------- -- ------- ---- Owner BY ...---- Title -... r.-+�r-•.---................... ........ [If other than owner) FOR DEPARTMENY USE ONLY APPLICATION ACCEPTED BY --------- -- ------- - --------- - ------------------------- ----------------.-��--.:n...DATE :--.�.�.`:�:-�� ._-'�.�..: BUILDING PERMIT ISSUED -------- •---- :..-. r_... - . — . , ..----•---------------------------------------------------•• __...-..-..._..._-DATE .....-....-----•---......�...-.....-....--- ADDITIONAL COMMENTS ---------------•- • ----.------- -------------•---•- -------------......- --------........................------------•-------------......----•--•-.........._...-_...---------...-------- ..-...- ---------------- ...................... —Final Inspection bate Ell 13 21a —6 v• 5MSAN JOAQUIN. LOCAL HEALTH DISTRICT 8/7h 3M i