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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT � (Complete in Triplicate) Permit No7Q� -- t - -- 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 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 _- .._%.�'--- /: -:__-,!� F '. .: �'_,_ ��.._.r�' :i. .CENSUS TRACT Owner's Name .- --- -/ ,`;'.', , ;'-�.:: ,{�.'- --.__ -_r-.. - _. -Phone Address .... .. .::-. . ,!'� ` ,�•-City �'� ---'--- ------Zip Contractor's Name __ _.-�-.- >__ -,_'� -L-tw ••„",{ -. - .License #,._. _. L;Phone_ _ Installation will serve: Residence ❑ Apartment House ❑ Commercial [] 1 railer Court ri Motel ❑ Other. i 6-711 1 - 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❑ Peat ❑ Sandy Loam ❑ Clay Loam M. 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK [ J Size_- .--f �.z-(• -- --..Liquid Depth Capacity i_o_L �,,--.,Aype r`---: . ^-'Material .c ., '' CNo. Compartments..- - r Distance to nearAst: Well _.- '_..v -✓� ' -r--- --- ----Foundation---i.ei_-..._.------Prop. Line LEACHING LINE } No. of Lines r__.. Length of each line ____ •'(i_ Total Length 'D Box -: /' Type Filter Material ,_ _.'Depth Filter Material Distance to nearest: Well ,"_: _ ---.Foundation. ---- -__-_.Property Line SEEPAGE PIT [ j Depth -_' __DiameterNumber __..___f.. .___.. _ ,Rock Pilled Yes ❑ No❑ [ Water Table Depth. ._ ____- -�.-. -____.Rock Size Distance to nearest: Well Foundation__ J__..----_.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 1 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 licensed 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 owner) OR EPART A NT USE ONLY APPLICATION ACCEPTED BY ✓rf -_ DATE - _/O { -7' - DIVISION OF LAND NUMBER _. :-_.__ . ._ _!f__ ..._ _._...DATE ADDITIONAL COMMENTS _ ----_----- . ..___------__.-._ -- -__--- -- _.-. Final Inspection by: ..... _----- ---_-:- .:_.. - _._---- ----- --- --DateEH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT ras ,6T/ REV. 7,76 3:r