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FOR OFFICE fUSE: ""�� '. ` _. "' r •:.:*�.., .. . X,. � `- APPLICATION FOR'SANITATION PERMIT 4 ----------------------------- Permit No- - --_�_6-_O. (Complete in Triplicate) --------------------------------____________------------- This Permit Expires ] 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: JOB ADDRESS/LOCA T N . /Q--- � G�/G lj®�- �/ CENSUS TRACT --------------- �� Phone = 1l� Owner's Name = - ---- Address Contractor's Name --- _._____ License # - z .___. Phone _= �7-- Installation will serve: Residence ❑ Apartment House❑ Commercialrailer Court ',❑ Motel;❑Other------------------------------------ Number of living units_____________ Number of ppbedrooms ____________Garbage Grinder ___ ._-'\- Lot Size _-7___---------------------------c---------- Water _______fWater Supply: Public System and name ------i------------------------------ ----------------------------------- ------- ------------------------Privat Character of soil to a depth of 3 feet: Sand;'❑ Silt❑ Clay ❑ Peat.❑ �Sandy;Loam [3„Clay Loam ❑ Hardpan E] Adobe Fill"II 'terial l-__ ----- If yes, type ---------------------------- - - r [Plot plan, showing size of lot, location of�`system"in- relationeto: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 ------------- I Capacity Type ---------- (Material--------- ------------ No. Compartments =Y Distance to nearest: Well -------------------------------------Foundation -----------------__Prop. Line ---------------------- LEACHING --------- ------LEACHING LINE [ ] No. of Lines ------------- -------- _ Length of each line_---------------------------- Total Length ,--------------------,........,f, R 'D' Box -------*---- Type Filter Material -----I-------------Depth' Filter Material --------- ------------------------_.------ Di stance ----`Distance to ne rest. Well I �_--- - -- - Foundation ------------------------ Property} Line -------------------- {� SEEPAGE PIT [ ] Depth . ------------- Diameter ______________= Number ------or,_-___I------------ Rock Filled Yes ❑ No ❑ s Water Table Depth -----------I-------------------------------- ----Rock Size ---- ----- ---.._..__' Distance to nearest: Well ___ ________ --------------------------_ Foundation -------------------- Prop. Line _____:_________-____• REPAIR/ADDITION(Prev. Sanitation Permit# -----------------"---- --------_-------------- Date ---------------------------------_} Septic Tank (specify Requirements) ----------------- ----- ----- - - ---- --------- ---`- ---'- - # -- . ________- -__.___ __- Disposal Field (Specify' Re uirem -ents) - :20W- - l _-e--- -- --------- ---- � t .,.(Draw existing and required addition on reverse side) I 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"Dittel'ct:Home owner or licen- sed agents signature certifies the following: k "` "1 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 b me ubje4t t Wor n's Compe tion laws of California." k t I t r� I Signed _. ------- / ! q k Owner 4r; a 1 BY ------------------------- ► Title�. --------------------------------------- - (If other than owner) I I 'DEP A ENT USE NLY u is o APPLICATION ACCEPTED bBY - ATE PERMIT ISSUED ------- - - - �--=- - ----- ---- -- -- ----------------------------DATE ----------------------------------------- ADDI ! NAL COMMENTS: `/ _ '. . ( ---------------------- r +��. --- ' rt.. x e----.w- � - 1 �{ f --- -r- -------- �. ,f ---------------------------------------- -- ---- Final I c n by---_-- ------- ----------------- -------- .Date --- - -" "AN JOAQUIN LOCAL HEALTH DISTRICT ; E. H: 9 1-'68 Rev. 5M