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FOR OFFICE USE: APPLICATION FOR SANITATION PEWIT Permit No: ..7..�.=�-g-S .............-------- --•------- ( [complete in Triplicate) `jl.l_.. Date issued .....................•.... _. '[Itis rormil Expirfts 1 Year prem�e�t&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 O-�'rdllinance Na_ 544 and existing Rules and Regulations: !OB ADDRESSAOCATION �;/^a-----CENSI.IS TRACT .1-417........_... ....Phone Owner's Name _ ---• f --- -..__ �//� _City Addressel X .I� -•.......................•---•------......_--_...._.._ Contractor's Name ------------ .. ---License# -- Phi ----------------------------- Installation will serve: Residence[]Apartment House Commercial]]Trailer Cevrt 0 Motel ❑Other------ ---------------------- •----••------ �.�� Lot Size Number of bedrooms - - Number of living units: .--'Y - --"-"- Water Supply; public System and name --------•---------•--_-------------------------- Character of soil to a depth of 3 feet: Sand 0 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 2I>Q feet) ,4 s PACKAGE TREATMENT [ ] SEPTIC TANK* Size!-- --s��'T'`•. Liquid Depth ,_-_.�_...--w......_ T �, -_-. Materioi..G�'�"---------- No. Compartments D Capacityp F_-- y ----- Distance to nearest: Well ---------•------•----------- ------Foundation __._-•--....---•---__ Prop. Line ------:------- ^� ---•------- •---- --.- Length of each line----------- ------- ------ Total Length ........_.._._...--•-•-- LEACHING LINE [ ] No. of Lines - - 'D' Box ------------ Type Filter Material .__Depth Filter Material ....................•----..- •---- -_� Foundation PeopertY Line --••-------•--•------•- �. Distance to nearest: Well .------.-_-•__- -•---' 13 SEEPAGE PIT [ 1 Depth ----------•--------- Diameter ------- Number ---------------------------- Rock Filled Yes ❑ No Water Table Depth ........:........Rock Size ------•--- ••- . Distance to nearest: Well Foundation • Urw ----------------••_... /ADDITION(Prev. Sanitation permit ...................... --- - � � _._..,. 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 Lays, and Rales and RegukM*m of the San Joaquin Local Health District. Horne owner or licen- sed agents signature certifies the following: person In such manner 1 certify that In the performance of the work for which this permit is issued, I shall not employ any as to born ubject t or n"s Compensation laws of California." Signed - _.......................... Owner ---- Title ...._---•-----------------------------------------------•------ f other than owner) " FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _-- --------------------- ......._..-------•......._.. DUi1fE A.-22*?_1..._----------......... -----•------•----.•---------•------_--•_-DATE --------._----_-------..._--- BUILDING PERMIT ISSUED .--- I ADDITIONAL COMMENTS ----• `- -- 1—6 - , *--- .. ..............•------------- ----•--........... _..... -__....--....-_ a:: ------------• - ----- ---.----- Final Inspection b . Y ..---..Da1�s _--�-•- -------------------- p� Y JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1268 Rev. 5M