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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ...............••- Permit No. ..7:5^7�.�• i (Complete in Triplicate) " ................................................ - Date issued This Permit Expires] Year From Date Issued OS3-15'a _t/ ...... . .............. .Application is hereby made to the San Joaquin Local Health.DWrict for a permit to construct and install the work herein described. This- application 's made,in compliance with County Ordinance No. 549 and existing Rules and Regulations: ^"..... �... CENSUS TRACT ............. JOB ADDRESS/LOCA ._.r. ..,_ p . .._. m. .., _. . Owner's Name ._ ---•--.. ....... .Phone ' A -y--�- Address .UC-0.�=�'.�r. .�• •,�...............•._ .....- .... .. C'ty � .. __.........._..........---.._........... ......... i / Phone/.. License # .............................. Contractors Name .:_.... y installation will serve: Residence C]Apartment House0 Commercial -OTrailer Court 0 f Motel O.Other.. ......... Number of living units:.._ Numberrof bedroomsrt...-••:Garbage Grinder -___... ---- Lot Size ....................... Water Supply:,.Public System and name ............=--=------• ---.----•-•--.--••- . . : ........................Private Peat Sand Loam Clay Loam Character of soil to a depth of 3 feet: Sand n' .Silt[� Clay ❑ ❑ Y Hardpan 0 Adobe 0 Fill Material ...._..._— If yes,type ............................ ; (Plot plan, showing.,size"of lot, location ofsystem in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or see age pit permitted i� public sewer is available within 200 feet,) i SEPTIC TANK Size-y .. ,•� /� Liquid Depth ..._4................... PACKAGE TREATMENT -( ] - ....... : Capacity � '.- Material .••_.._ No. Compartments - - ---..... :I.�...:mVType - _ I r. } Foundation Prop. Line -� •• Distance to nearest. Well _.lP-•J�•• /'"Y' " ""' LEACHING LINE [ No. of Lines ______..L - .......... -- Length of"each line._......1._Q.u._,..._..... Total Length _.f Qom••••••••-__.._... 'D' Box Type Filter Material ...::.U.•.-.....Depth Filter Material _..�`� - ..: fl I f ` '-.: Foundation ..._./. --__-- Property Line ......? Distance to nearest: Well ...__._. �. � 3 * Number .r.-Z............... stock Filled Yes [ No SEEPAGE PIT Depth _ Diameter ................ i Water.Table Depth ..-----•--••-- ��1.�_... ` . ._._... oc ze . s ate:„ .....Foundation 1W. Prop. Line ... ._._.. .... Distance to nearest: Weil REPAIR/ADDITION(Prev. Sanitation Permit�# . Date ............ ► Septic Tank JSpecify Requirements) ..............•---•.........------••---••------••• ................... I ................. ` Disposal Field (Specify Requirements) ............................................................. --------------------------------------------------------I ----------------------------- •--------- - -I---------• .--•- ........................ ._... ::......---.._._....--•--........--•--.._.._...--••- { ----------------- --------------------- • •••--.......-•-----------_._...I.....•--•-• (Draw existing and required addition on reverse side) . [ 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: arson in such "I certify that in the performance of the work for which this permit is issued, I shall not employ any p manger as to become subject to Workman's Compensation laws of California." Owner . Title .._ .......................: By .......... ... _ (If,other than owner) t , FOR DEPARTMENT USE ONLY i t APPLICATION ACCEPTED BY _ -. ........::.....••---•....... DATE ---...... ... ' BUILDING PERMIT ISSUED ADDITIONAL COMMENTS `,G '/7r... � .C��r •. + S ........................................................................ ; ._..:._ _ ... -•.. ............. ........................I............._.......... --------------•-•-•-•-..._......_......•--•• . .. a-- Final Inspection by: ...-Date .'..-:..r _ i SAN JOAQUIN LOCAL HEALTH DISTRICT , L u 13 24