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FOR OFFICE USE: ................... APPLICATION FOR SANITATION PERMIT .......... (Complete in Triplied,te) Permit No. ..................... ......................................................... Date Issued .��.. ............................................... This Permit Expires 1 Year From Date Issued — ds3—tam —rS" Application is hereby made to the Son Joaquin local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rue4' 'W"Im u atio ? —S�fl:E ►�f` -�`t! ' � *CJO ADDRESS LOCATIO •^ a!`. _ ENSUS TJ Owner's Name �. .. ....... .. Phone, ei Address ............._ �.. �.. _�...... ............City -all o................_................... .. . Contractor's Name ........../... ... . .. .............License # .4&.7 Phone Installation will serve: Residence❑Apartment House Q Commercial OTraller Court 0- Mete) ❑Other Number of living units:.....I..... Number of bedrooms ....";L Garbage Grinder ............ Lot Size .^'�--z--�� 1............. Water Supply: Public System and name ............ Private .._ ...... . •..................--•................... c Character of soil too depth of 3 feet: Sand B -Silt❑ Clay [Peat❑ Sandy Loam o Clay Loam o Hardpan[❑ Adobe❑ Fill Material ............ If yes,type ............................ q (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 seep ge pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK j Size. 1�?___X-1�..�.................... Liquid Depth ....Sri.................. Capacity�,�0�0_0....... Type :... Material..�+^�Ca_.. No. Compartments ... ,.�...:......:.. Distance to nearest: Well ............. ............Foundation Prop. One -.n _....... LEACHING LINE [ No. of lines ......_.).............. Length of each line......... Total lerigtii ........ 'D' Bax ....... .... Type-'Filter M6terial .... .: :......Depth Filter Material ..... ...........................:... Distance to nearest: Well .......%5.0,4e.... Foundation ...:1.11_ ....... Property Line ....... SEEPAGE PIT [ Depth .... ��_- Diameter ___. 3.�_. Number ..._......2....._..._..... hock Filled Yes No j] Water.Table Depth T'b a > ...Rock Size -1..YA...Y.3......:... , Distance to nearest. Well .......t.Q_a._�. ...............Foundation ...J.0 ..... Prop. Line ... REPAIR/ADDITION(Prev.Sanitation Permit# _...__...................:......__.....____. Date ..................................) . Septic Tank (Specify Requirements) ........................................... Disposal Field (Specify-Requirements) ---------..I.............. ...................................... ....................................................................................................._............. ' I ............................................................. ......................................: - •._..........._.....__.......-•--------•-............--•-•-..............._.......I....... (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 at )icon. sed agents signature certifies the following: "I certify that in the performance of the worn for which this permit is issued, 1 shall not employ any person In such manner as to becomw subject to Workman's Compensation laws of California." Signed ......................•• ._... ...........................•_. Owner w ................... ...................... (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ..... DATE ...��. .�•.3..��--+� ....-•.----. BUILDING PERMIT ISSUED.......... ........... ..... ._..:: ._ DATE _:...... ..:.......... ADDITIONAL:"COMMENTS ......� ...................... ....................... .:.....• ---.....-----...............................----- ----.................. .......................................• .........._............ Y .................._........._...._...................................I.......... .................................................................�. ........ . 1 ....' _ Fina Inspection by: . ..............................Date .__.....f�/.,�Oyz� SAN JOAQUIN-LOCAL' HEALTH DISTRICT E.H.13 24 1-'68 Rev.SM 7/72 3