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r FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. ........... ....... This Permit Expires 1 Year From Date Issued Date Issued /a-:...... � 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 Count Ordinance No. 5 9 and existing Rules and Regulations: t �. ,t -- , .. r. . JOB ADDRESS/LOCA ON ... . :-jam.--d�'�;._ i ..... -• .. . . .... CENSUS TRA Z°7 Owner's Name ....... ©. (.?. 1 ` ...... Address ..- --- o -��. . ..... �._. . h ne - ....... 1!s�.__..f � Contractor's Name ... �-..._..- .f��.....�.��-�� ..p..+.._ Phone Fee.2.,: _P Installation will serve: Residence11partment House'] Commercial [-)Trailer Court Mote ❑Other .....•/.. ................................... I: 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 D Silt❑ Clay [] Peat E] Sandy Loam E] Gay Loam . — Hardpan IV Adobe ❑ Fill Material ............ If yes,type (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed ort reverse side.} m NEW INSTALLATION: INo septic tank or seepage pit permitted if public sewer is available within 200 feet,) I PACKAGE TREATMENT [ } SEPTIC TANK Q r/ Size....... r Liquid Depth capacity �� Type _ !`...f_..._ Materigfo Compartments..al; to nearest: Well . -Q.......................Foundation ...... ........... Prop. line ..._�_... ------ - LEACHING LINE No. of Lines Length of each Iine ........Af.D........... Total Length ..._I8.............. 'D' Box ...'. 1 r1 qc��i r _ Type Filter Material ..__.�.�Z....._ Depth Filter Material __.VCT1.11 Distance to nearest: Well _.:... .0_,._.- _ Foundation Property Line Property t SEEPAGE PIT [ ) Depth .J� ..___—Diameter _..... -•--�. Number _._._. . .... . p � -- f--....y�.-. Rock Filled Yes No i0 Water Table Depth ....... ................. ...... .............Rock Size --./, z;" Distance to nearest: Well _...... 9©........................Foundation -.- .. Prop. Line ........................... REPAIR/ADDITION(Prev. Sanitation Permit�# ......................................... - Date .................................. �- } � � Septic Tank (Specify Requirements) ....... ........ ..... Disposal Field (Specify Requirements) ................................. ..................................................... ........... . .......--.... ......_................� -- ._. . IDraw 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. Nonce 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 ubi ct t W man's Compensation California." Signed .:.. .................... caner By .... _ . ...... f ther than owner ' .......... . ..... ................ FOR DEPARTMENT'LISE ONLY I APPLICATION ACCEPTED BY ... ...... ..... .. ......... DATE ....... BUILDING PERMIT ISSUED .----•------........ .................. .......... ................__._. ADDITIONAL COMMENTS . .-.... ................. ........................... .................... ... ..............DATE _ .....................I................... ....................... ............... ............................................. .................................... .. .......................................I. _......................... Final inspection by ................................................. ...............•.Date... ` O SAN JOAQUIN LOCAL HEALTH DISTRICT c u 13 24