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FOR OFFICE USE: �"-"��'; ,�:< APPLICATION FOR SANITATION PERMIT ....................................... ...... 7,C s C2 .............. (Complete in Triplicate) -Permit No. ..................... V Date Issued ..-._. .... -------------- - ---------_____ 'Phis Permlt Expires 1 Year From D ftIssued 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 Regufationss JOB ADDRESS/LOC TION �..___--t.,�.-.. .......................................CENSUS TRACT .................... ..-.._ Owner's Name -�,�... ..............Phone ...... ...............-............. Address ......... ... .................. L,.,,L......City . . ....---.-57n...•.._._._...._._...._.._.__...... _ ..........._...... Contractor's Name ....._-.- -- - -�' ..__ ......_. x ..-. �{�. License# .�1 �y Phone ......:................. . Installation will serve: Residence Apartment House TI&Mmercial❑Troller Court 0 Mote! ❑Other..............•-•••---••-----.............._ Number of living units:............ Number of bedrooms ------------Garbage Grinder ___.___..— Lot Size ...........................................11%%. Water Supply: Public System and name .Private❑ b Character of soil to a depth of 3 feet: Sand'❑ Silto: Clay ❑ Peat❑ Sandy Loam ❑. day Loam ❑ Hardpan Adobe Fill Material ............if yea,type............... .. ............ (Plot plan, shawl ng.,size of lot, location of system In relation to wefts, buildings, etc. must be placed on reverse aide.}�� f NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANKfT Size.- 1B_ -, .................... Liquid Depth ..V............... • Capacity -1600 Type _ -- --___ . Material .... No, Compartments ..rte::..... ....._ we? �f Distance to nearest:a .�Well .......... •,p_ .- ._.___,Foundation �� . .........Prop. Line LEACHING LINE [l� No. of Lines ......... ............ Length'of each line-------' .... Total 'D' Box ..__./..:.... Type Filter Material _.__5j_C.......Depth Filter Material _..'41...:............................. Distance to nearest: Well ...... Foundation ......1_V ------- Property Line ..s .......... _ ' "T ............... Rock Filled Yes No 0SEEPAGE PIT { Depth --r✓�ar�.�-- S�iameter �}�......... Number ..:.'^:"�� ff N Water Table Depth .._...-y______,[- -_ ..,..._Rock Size I. x-.'$.......... Distance to nearest: Weil`..`....��n.. ...:—Foundation Prop. Line ,-i—C-41......... REPAIR/ADDITION(Prev. Sanitation Permit# .................._....______................Date _--•---------.....................I ' Septic Tank (Specify Requirements) .................................. Disposal Field (Specify Requirements) -------------------- ...._._...__..__._____ ................... -------------------------------------------------____.................•----•.......----•-•-•-•------•-•--•- .......................... ......._...__......_._._...._.....-•--....•-••............._.._. ..................... --••-;-- --••............. ...................••-------....................._•--............................................................---.......,..,............... (Draw existing ond,required addition on reverse side) I hereby certify that t have prepared this application and that the work wiff U done'ih accordance with Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local HeaIlh,Distrlct.Horne 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 chaff net employ any persen In such manner as to become subject to Workman's Compensation laws of California." Signed--------- ..................................... - ,. Owner Of o BY -----------------•...-o----ther than own-- -•-- n er) -------- Title ................. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- ------------- •_-. - . DATE _tl' Z. -�__ ._......__.._: .- ---•........................ BUILDING PERMIT ISSUED ................ . ADDITIONAL COMMENTS --------------:_.........._....-............._.... - -------------------------------------------------- ..-•------ -•----..-__.•.---......... ---._....__._..... ............ .............I....... - • - ...... ---•-------.----------------------------------------••••-•_-----..---•----- .. Final Inspection by-- �MrAu Date ..�._... _......... y. _ _ . . Edi 13 2L 1-68 1?ev. SAN JOAQUIN LOCAL HEALTH DISTRICT 8`71! 3M