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FOR OFFICE USE: � FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ...... (Complete in Triplicate) Permit ------ �) 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 and existing Rules and Regulations: � Ifs JOB ADDRESS i LOCATION / .............. .... ..... .... .C^C .... CENSUS TRACT Owner's Name.... --- L-e_S ... -Phone Address..... ._... ill'-C- ' .._City.... �. ►. NZip e'a'r°" _ Contractor's Name. _ /s.p-t-�._. rtti�h.o-,P— ---~License #�.'Z.��- . . .Phone. Installation will serve: Residence , Apartment House El Commercial C Trailer Court ❑ i Motel fl Other ... . _ Number of living units: ....I._ Number of bedrooms... Garbage Grinder ' 3 . 9 Lao lot Size.---- ....../g� ��._ ._... . Water Supply: Public System and name ..:.... ....... _ Private (� . ... ..... . .... ............... Character of soil to a depth of 3 feet: Sand ❑ Silt[j 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 200 feet,) PACKAGE TREATMENT ( J ' SEPTIC TANK ( J Size--........ . ....... -Liquid Depth -...... . .... Capacity- ....,Type... ..... Material..... ..........: ..No. Compartments ...... ... Distance to nearest.. Well . ...... _-••. Foundation . Prop. Line . .....- . LEACHING LINE ( ] No, of Lines ............. Length of each line.... ...... Total Length ..... ..... ....... Box... .. ...Type Filter Material.............. .. Depth Filter M_aterial.. .. ....... I Distance to nearest: Well _ ... .....Foundation ..:.- .... . ........Property Line ' ....... .... SEEPAGE PIT ( j Depth ....Diameter :-..-..` . .Number............... Rock Filled Yes ❑ Not(] Water Table Depth......... ... . ..--. .......... Rock Size x ...... ......... ' -Distance to nearest- Well __.... .. Foundation... .... . ...... Prop, Line................... ......... REPAIR/ DITION (Prev. Sanitation Permit# _ ......... ..Date 1c Tank (Specify Requirements) ........ ...... Disposal Field (Specify Requirements)........ . ..... .y(a.- .. ......... --. .. . x . .ui o.... iv.. .... .... ...... ...... ..... ............ ... ...... . .... ... (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 the San Joaquin Local Health District, Home owner or licensed agents signature certifies the following: "I tertify that In tWpelormance of'the work for which this permit is issued, I shall not employ any person In such manner as to become sub( kma mpensation laws of California," Signed.-.._ , Owner By...- Title. (If 'other than -owner) l R DEPARTMENT SE ONLY APPLICATION ACCEPTED BY.- ..... DATE .. DIV ....... - ISION OF LAND NUMBER , DATE............. . . . .---- ----- _. ......... ADDITIONAL COMMENTS ... ........ .........- . ... . ---------_....... .......... ... . ..... _ --........... =inol Inspection by:...... . ......... .... ... -- .......... ........... . ...... -•--- _ Date/D `� _ -------- .-... !+ 13 24 S JOAQUIN LOCAL HEALTH DISTRICT FRS 21677 REV. 7!76 3M r_40�