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FOR OFFICE USE: 2—:3APPLICATION FOR SANITATION PERMIT l --------------------------------------- - Permit No. _r44',��_c� (Complete in Triplicate) ----------------------------------------------- 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 complian a with County Ordinance No. 349 a d existing Rules and Regulations. �JOB ADDRESS/LOCATION .__._ _'a�� _ -_V-,Aj -�-�-�c�..,�._.��_. ---�IµSEJS TRACT -------------------------- Owner's Name -� ---------------------- - ----------=-------------------- Address ____ ---- City Phanel- .3�- ---------•--•--- � Contractor's Narfe _ PhoneW- __._- Installation will serve: gResidenceAApartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑ Other -------------------------------------------- Number of living units:----- Number of_.eclrooms ___ __ .Gar ge Grinder ------------ Lot Size :�_._7 .______ Water Supply: Public System and name --------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ ilt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ AdobFill 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 [ ] SEPTIC TANK'[ ] Size------------------------------------------------ Liquid Depth -------------------------- Capacity -------------------- Type -------------------- Material----- ---------------- No. Compartments ---------------------- to Distance to nearest: Well __________________________________Foundation __.------------------- Prop. Line ____________________._ l LEACHING LINE [ ] No. of Lines _______________________ Length of each line__________--_____._.______ Total Length .___--__----_________.______ 'D' Box ------------ Type Filter Material ____________________Depth Filter Material ----------------------.------............ ... Distance to nearest: Well _______________________ Foundation -------------------- --- Property Line ________________-_-___ SEEPAGE PIT [ ] Depth __._____---- ---- Diameter ________________ Number -- --- _________ ----------- Rock Filled Yes ❑ No i0 Water Table Depth ------------------------------------------------Rock Size - ------------------------------ Distance to'nearest: Well _______________________________________Foundation -------------------- Prop. Line _______-.________--_- REPAIR/ADDITION(Prev. Sanitation Permit# --_____ -------------------------------- iDate ----------------.----------------- Septic ___--___________Se tic Tank (Specify Requirements) ) --------------------------------------------- ---------------------------- Disposal Field (Specify Requirements) ------- ------------------- ______________________'____ : --.c—_-- --- ---------- CIN E� 94 AZ4j (Draw existing and required addition on revege safe) 1 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, I shall not employ any person in such manner as to bec su/ jiect to Wo kman's Compensatio laws of California." AllSign - Fcl- ----,-�-p------------`art BY ------------------------- ----------------------- <�- ad Title --------------- --------------------------------- ---------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------------- ------------------------------------------ DATE -----_; '+ ----------- BUILDING PERMIT ISSUED -------- - - ---------------DATE ------- -------------- - -- ------- ----- ADDITIONAL COMMENTS ' ------------------------------------------------------- --------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------ ---------------------------------------------------------------------------------------------------- ------------------------------------------- -- - - ------------- --------------------- --- ----------------------------------------------------------------- --------- ---------------------------=------- Final Inspection b r_ __Date _ _____________________ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M