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.V.• �v. . 1VL VJ�.3 'LICATION FOR SANITATION PERMIT ................................................... 14%r, (Complete In Triplicate) Permit No. l .l ..............................:....................... .,- 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 Regulationse !OB ADDRESS/LOCATION . r�.� L' F�!.....:. ......... .. ?_ ` "..................................... CENSUS TRACT .......................... �. . . Owner's Name .......... .... ..... .............t;!.c............................................................. Phone .................................... Address .. , ................. 'I_ •� • ....e................. city ��-:..............._....................... ................ . Licens #Contractor's Name ....... c .Z..... Phone .............................. installation will serve: Residence ❑Apartment House C1 Commercial ❑Traller Court C]Motel ❑Other �? `....... ................ Number of living units:------- ---- Number of bedrooms ............Garbage Grinder ............ Lot Size .... ........... Water Supply: Public System and name ........................................................._......._..........................................Private Com; Character of soil to a depth of 3 feet: Sand 0 Silt❑ - Clay ❑ Peat❑ Sandy Loam GT"'C:1ay 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.) NEW INSTALLATIONa (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK[ ] Size-...................................... Liquid Depth .......................... 1 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 Motorial ....................Depth Filter Material ............................................ Distance to nearest: Well ...... Foundation ........................ Property Line ........................� SEEPAGE PIT ( ) Depth .................... Uiameter ................ Number Rock Filled Yes ❑ No QQ Water Table Depth ................................. ----.Rock Size ................................ a� Distance to nearest: Well ........................................Foundation .................... Prop. Line .................. REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ..................................) Septic Tank (Specify Requirements) ................................................................................... . .r-- Disposal Fiela (Specify Requirements) ._a-`��t__...i`5_.-�h�-....... _ J` :.. .......................................... L. ' ` .................................. T.......-- --------- --•---------•---...... ------.....�. ... . ---•------.....................---••-----••--•--.........---.............--•-------•-•--- ............................................................................................................ .-------•------••---•-.... ...........................--------------•...---........... (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 tho 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 Workman's Compensation laws of California." Signed .... ....................... 7 ..............n...... . Owner By ..... ........... .... . .. . ..C.✓1�J.1 Eo ..Z:.r...... Title .. <, ~-a (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ...... DATE ..... .............: BUILDING PERMIT ISSUED ................ .......................................DATE . .................................. ADDITIONALCOMMENTS .........................................................._..._..._................................................................_.......................... ....................................---.....--•--......................---...............---...........--•-•-------. ....................-•---........ .................................................. __. ..........................................•---....... -- -•-•••-••............................................. ...............I ...... .............-••-. ........................ ....... .......................... .............. ....... . � ...... ..... .... ........ _. ... FinalInspection by: ........................ s................................................................... ....................Date ... ................... Ell 13 2b 1-68 itev. c,-m SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M rA---.,