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4 FOR OFFICE USE: -.PPLICATION FOR SANITATION PEk....T ---------------------------------- (Complete in Triplicate) Permit No. - I :- This Permit Expires I 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 with County Ordinance No 549 and existing Rules and Regulations.. JOB ADDRESS/LOCATION .--.-o93.6 _-- # ---1- '-- ` -- ------ -------------------CENSUS TRACT __._.+ .T --- -` _ Owner's Name --- /, l' -------------------- -------Phone . }�1 �3 Address y 7- --- ............ City _ L_2je7.�~-------- ........ Contractor's Name ` -------------------------------License PhoneY2 ` Installation will serve: Residence ❑ Apartment House,❑ Commercial ❑Trailer Court ,❑ Motel ❑Other --------------------------------------------- Number ---------------------------------------- _ Number of living units:-._-_/____. Number of bedrooms _.______Garbage Grinder --_.--.--.-. Lot Size -/ -- !----------------------------- Water -- "TWater Supply: Public System and name ---------------------- ----•---•-•-----.-...---•-----------------------------•--------...----------............Private [� Character of soil to a depth of 3 feet: Sand'R Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe❑ 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.) j NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,l PACKAGE TREATMENT E I SEPTIC TANK'[ ] Size--------------------------------------- ---- Liquid Depth _.------------------------ t { Capacity __................ Type _.------- --_-`-_-- Material____--._r= ---------- No. Compartments I Distance to nearest: Well --------- --------------------------Fou ation --.------------------- Prop. Line ----------------.----- i LEACHING LINE . [ ] No. of Lines ------------------------ Le gth of each line-- --_--.-----------------. Total Length :---------------------------- F 'D' Box -------.---- Type Filter M terial ------------------- epth Filter Material ----------------------------------.-..-.--_._ Distance to nearest: Well .... ................... Found tion -__-.--__--_-:_--.--._- Property Line. _____.__-____---__-_.___ SEEPAGE PIT j ) Depth ._.________________ Diam er _.....-_.._._._. Nu bei --------- ------------------ Rock Filled Yes ❑ No i❑ Water Table Depth ------- -- ---------- Rock Size Distance to nearest: We ---------------------•---------- --_..._Foundation -------------------- Prop. Line ....------------------ F. REPAIR/ADDITION(Prey. Sanitation Permit# W/ ------------------------------------------ Date ---------.-•._--------------------) SepticTank (Specify Requirements) -----------------------------------------------------------•--•------••-• -------------------------------------- ----------- Disposal Field (Specify Requirements) --------------•--- ------------------------- ----------- ---------- -------------- ---------- - -- ----- -- d(j- ------ )------I ------- J C? L /`�'/ - j`'.C, x�./ �f`� ------------------------------------------------------------ (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- ( F 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 becorne subjeSt to Wo an's Compensation laws of California." Signed ---- --------------------------------- Owner BY - ✓ = Title -------------------------------------------------------- ------ -- - ------..._ . (If other than owner FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------- -i'1'- ------------- .--------.----_---.-_. DATE ----4-'—ln7 .. L BUILDING PERMIT ISSUED ---------------- ------------- -------------.--------------------------- --,----DATE ---- ------ ADDITIONAL COMMENTS --------------- ------------ ---- -- --------- - ------------------ ----------------------------------=--------•------------------ --------------------------------------- --------- ----------------- - - ------ ----- -------------------- ------------------------------------ ------------------- -- s ------ --------------- -- ---- -- - - -- ------ --------------------------------------------- F` Final Ins --- Date --.. -. .. �. { SAN JOAQUIN LOCAL HEALTH DISTRICT