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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ....... ------------ .............. --- (Complete in Triplicate) p -- P Date Issued _d.. l�_C.-,z ----- This Permit Expires 1 Year From Date issued of Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the w6rk herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: 2'5'77 S S • ? JOB ADDRESS/LOCATION ----- CENSUS TRACT ---s4S -.---• -• Owner's Name d --------- ---Phone ....•._•---- ----------------------- Address ......._n............. � � --------------__ City _ -----•_-�-�••---__----.-�-•----- . Phone Contractor . Name License # J 1 Installation - will serve: Residence ❑/ ta1] hrtment House Commercial ❑Trailer Court , Mote ( er Number of living units:.kf ... /� 1 Number of bedrooms . _:._....Garbage Grinder = . __: Lot Size .___.. •: Water Supply: Public System and name -.-----_ _.... ...._.. -------- Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam F}-•--- Hardpan ❑) Adobe ❑ Fill Material .. _ If yes,type .__. ._.•.---------- (Plot plan, showing size of lot, location of system in relation to wells,.'"" s, etc. must be placed on reverse side.) y� NEW INSTALLATION: (No septic tank or seepage pit per^ itted if pubic sewer is v lable within 200 feet,) PACKAGE TREATMENT [e] 5EPTICTANK Size. 5�.._ '�Qf�---- --'------- -• Liquid Depth .y.�--.-------•-•--- Capacity 1c� - Type ---- - No. Compartments ..�. !-..... - .._. Distance to nearest: Well .-.f ......................Foundation ...16... ---- Prop. Line .....16_ -_.-____-..•_ LEACHING LINE [ ] No. of Lines -----j3. --------- length of each line---- - Total Length -o? ............. 'D' Box Type Filter Material �1._9�--Depth Filter Material ___&. .......... ......••......••••• er Distance to nearest: Well ../6 -f6undation .-_.IU... _.____... Property Line _..- ... ------ De th _ Diameter ... Number .............................Rock Filled Yes C] 0 SEEPAGE PIT [ � p ---- Water Table Depth ---•----- - .........................._......Rock Size ------ ------- .------ Distance to nearest: Well ...-................................Foundation . ----------- Prop. Line ....... --------- REPAIR/ADDITION(Prev. Sanitation Permit+ --- ..........'..... ..................• Date .........____..........-...-) 'f Septic Tank (Specify Requirements) -------- --- -------------:,-.,_...- ----•---------------_ \ Disposal Field (Specify Requirements) _. --- -------------- ------------------------ ................. . .. (Draw 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. 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, 1 shall not employ any person in such manner as to become sub'ect to Work Compensati n I ws of California." Signed j� - --------.-. Owner 1� --------------- Title . . ----- -------- ----- t (If other than owner) FOR DEPARTMENT S ONLY APPLICATION ACCEPTED BY ------------------- - ---------•••... DATE BUILDING PERMIT ISSUED -----------------•• _--------- . ...... ...... ............_-DATE ADDITIONAL COMMENTS ------ ------------•-. = --------------- -------------------------------- _ --------•---•------......•-_....,--- ._....i,-------- ----•--•--•- �561/ --- ------•- ••--- -. - -- ... •. .. . ...................••--_.......•----- -___........•._...........-- ..................Final Ins ection b _ .Date ...- :0 -4� _-----------------.SAN JOAQUIN LOC LTH DSS RI E. H. 9 1-'68 Rev. 5M