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FOR OFFICE USE: APPLICATION FOR SANITATION PETIT J� - - - Permit No. _- -7o_-- -• (Complete in Triplicate) _y<_��' This Permit Expires 1 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 nd existing Rules and Regulations: JOB ADDRESS/LOCATION ..- -- _ �--_S--_-- -- � - •� r-.-- --.CENSUS TRACT -------------.------. Owner's Name 1 �? ------/ ----- ----------------------------- Phone Address � � `! --------- City _ 2 --- . Contractor's Name C_ __:' z' =J �eYZ—o,C ---- --- License #. -_ � J Phone �l-'-------------------- - Installation will serve: Residencela Apartment House❑ Commercial ❑Trailer Court I❑ Motel [-] Other ------------------------- Number of living units:- f - --_ Number of bedrooms -____Garbage Grinder _ _ - ..__ Lot Size �-��'---"_f ------------------ Water Supply: Public System and name ------------------------------------ - - --- ------ - --------------- -------------- ----------Private Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe K 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.) U NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) , v PACKAGE TREATMENT SEPTIC TAN '- Size---�'�- ------ ----------- Liquid Depth ----y� ----- -y--�---------- Capacity 1�4-U---,-- Type�`_ 4 ��__ Material_ No. Compartments a Distance to nearest: Well - -__ _ '_____ -__.______Foundation _-/«------------ Prop. Line ____11t�- LEACHING LINE No. of Lines . ___ f- -_ . Length of each line.... Ye ------ Total Length ��_,� ______________ D' Box _._f -_ Type Filter Material s�`hDepth Filter Material -- _ - ___-________•-•---- ------- t Distance to nearest: Well - -- ---- Foundation--l �-___________ Property line __ G't�'.__ SEEPAGE PIT [ ] Depth __ _ Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No 1(] Water Table Depth - --- - - ----------------------=-•--------Rock Size ----------------------------- Distance to nearest: Well - -- --------------------------------- ---- Prop. Line ___..________________ REPAIR/ADDITION(Prev. Sanitation Permit# -------- -.------------------_---_ - - --- Date _'__._____________._--.._____-_) SepticTank (Specify Requirements) --- ------------------------------------------------- --------------------------------------------.,-------- -- ------ ----- --- Disposal Field (Specify Requirements) ---- ------- ------------------------------------ - -------- - ------------------------------------ - --- - -------- ---- --- - ------ - - -- - - ----- ----- --- -- - --------------------------------------- ---- . ---- -- - -------------------------------- ------------ - - ----- ------ - - ----------------------------------- -- - --------- - - -------------------- ------------- ---- - - (Draw existing and required addition on reverse side) 1 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- sed agents signature certifies the following: "I certify that in the performan a of the work for which this permit is issued, I shall not employ any person in such manner as to beco e s bjeIttWork n's ComperLs tion laws of California." Signed --- --- --- - -- ----- Owner ---------- -------- Title -- -------------- --------- (If other than a eer FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- - - _- -_-�s__�:_A_ 1�.------------------------------------ DATE ----��G ----------------_- BUILDINGPERMIT ISSUED ------ ---------------------------------------------•----------- --------------DATE ------------------------------------------- ADDITIONALCOMMENTS -------------------------------------------------------------------------------------------------------------------•-------------- ----------•----•----------- -------------------------------------------------------------------------- -----------------------------------------------------------------------------------•----------------------- ------------------- ---------------------------------- -•---- -------------------------------------- --------- --- -------- ---------------------- ----- -c-- 7-j-------- Final Inspection by: ___. ____.Date _____�-_-----__ _-_ " SAN JOAQUIN LOCAL HEALTH DISTRICT r n •ce n-.. CAA