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FOR OFFICE USE: u APPLICATION FOR SANITATION PERMIT , 4 kk _...... -.... ... ................�a Permit No. ...... ......... (Complete in Triplicate) 3.--_-•---..._.... ......... �- m This hermit 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: JOB ADDRESS/LOCATION CENSUS TRACT ................. ...... Owner's Name �: .. _..... � __......._ .. ..............Phone ................................... Address ....40 .. __... .. .....: .... ..... ... . - . .----- .... City _ . .. .. .. ... ........... ......................................... �� .... r7 `` Contractor's Name .. -✓ _.•.................• License #fFZ3., 3�.. Phone ........ ............... Installation will serve: Residence ❑Apartment House•❑ Commercial ❑Trailer Court ❑ Motel ❑ Other __ .=:p.__t --. Number of living units:----- Number of bedrooms __y_._Gorbage Grinder _.........._ Lot Size ....................... ------------_--_-- Water Supply: Public System and name .................... .•--------_-------•-- -_....------------------------------------ ................. .......Private Character of soil to a depth of 3 feet: Sand❑ ilt I] Clay ❑ Peat❑ Sandy Loam 0 Clay Loam ❑ Hardpan Adobe C3 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 see. ge pit permitted ifgublic sewer is available within 200 feet,J ! ----...•---f PACKAGE TREATMENT [ ] SEPTIC TANK f5ixe._��..�.,�r.�...�..�.`. -/�. �___. Liquid Depth ._.f�.......... J Capacity Jcz '4._ ._. - Type .. Material_. Y-. No. Compartments a -_�..........� Distance ton rest: Well ----------. .........Foundation .._ lG!. __._.-...Prop. Line . :5 ...............�J LEACHING LINE ] No. of Lines —_..- g g -__-.._ Length of each line----._..,��' Q............. Total Length ---1.49.2V............... •D' Box ----/...... Type Filter Material ......5. .:._.Depth Filter Material -_-J41. / �.......:........� ....... Distance to nearest: Well --•-••--� .... Foundation ........_ .__........ Property Line • .- --• - �I . SEEPAGE PIT [ j Depth ..rrr��..�. ___ Diameter .. .`. Number ..........;;Z-----------.- Rock Filled Yes No ❑ .................... Rock Size l -- Water Table Depth ................�_�_...-•-.- .... Distance to nearest: Well ..._..._�pQ......................Foundation ..../4?........ Prop. Line ................. REPAIR/ADDITION(Prev. Sanitation Permit# ........ Date I Septic Tank (Specify Requirements) .................. --.... ...............••••-••-------•---••-•---..................•-•------------------.-•-••- DisposalField (Specify Requirements) ................... .----•................ -------------------------------------------------------------------------------------- 3 ..................................... _..........--------...-•••------••------•---..........-••---••------- --------- --------------- •-----._..__._._._.........._._..--.---•--.............-------........---------•-------_._........_..--- ............................................................. (Draw existing and required addition on reverse side) 1 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. Horne owner or licen- sed agents signature certifies the following- "I ollowing-"i certify that in the performance of the work for which this permit is issued, 1 shall not employ any person In such manner as to become subject to Workman's_Cgmpansation laws of California." Signed --------- ----------------------------C. Owner By . _----------------------- ---- ---- ......: `--------- Title - -----._..... ---------- ............... (if (If other than owner) ., FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED SY ........ ---' .....................•---............................_....................... DATE ..l.-31; ....._.......... BUILDINGPERMIT ISSUED _. ./_. .... .. j -- -----•---------- ----•--—............_..... --------..........DATE ........................................... ADDITIONAL COMMENTS _._ -{ � .? (/- C� .............. ---.---.---- ._................ ............... .................................:................................. ........................................................------------------. ........................ ......................... ..--....... _ ........I....... - Finalinspection by: ...._...��----------------•-•-••----.._.-•---...-•---.....---,..........---.............-----------...---..Date .._ .. ...�,�--Z��------........._..._. SAN JOAQUIN .LOCAL HEALTH DISTRICT E. H.13 241.'68 Rev, 5M . _ - 7/72 314