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FOR OFFICE USE. I... APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No, .'3..._._..._... This Permit Expires`i 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: JOBADDRESS/LOCAT#ON .......oG' ,. ._ .:.( !`"_- ~.._... .. ..............CENSUS TRACT ....... ............ Q Owner's Name � .-. ..._.._'# ....-..-- ....... . 2.--•------------------• - - --- :_..Phone ..l Fig Address ir�l' . . .. _. Address ........ .._: U.. ._. f------------------- City ---.. ..................................... Contractor's Name .... - '• r,Dt,- /d.r ._-- ------.License #XC.7477. Phone Installation will serve: ResidenceXApartment House,❑ Commercial ❑Trailer Court- 0 Motel ❑Other ................. Number of living units:_...„ Number of b drooms s � . . - �� -----Garbe a Grinder" .. lot SizeS.............................. Water Supply: Public System and name - --- ------cld --------------- .........................Private ........ ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay [] Peat❑ Sandy loom Q Clay Loam ❑ Hardpan 0 Adobe K;w 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+ank or seepage pit perrriitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TAN K-f ] kg's iz -------•---------------------......:,.......... Liquid'Depth ................... Capacity .. . ..... . .. Type .................... Material.------ No. Compartments i Distance to nearest: Well . .... ............ .................Foundation ..............-..__ Prop. Line .................. LEACHING LINE No. of Lines .. . ..-_ Length of each line .......-66 . ...... Total Length -_---.-:_. 'D' Box - Type Filter Material• _.....Depth Filter Material _. -.................'___._..._._ Distance to nearest: Well ..... Fo n i u dat on _l__/._._..:-... ... Property Line ..-S ............ SEEPAGE PIT [ Depth 4- Diameter 1.S1..Z./rNumbe. ...........f.-,..- Rock Filled - Yes No ❑ , { Water Table° Depth -......... ------.-_- ,-• --.-.Rock Size -....,�" - ... ._ Distance to nearest; Well .-_.,��C}-_CSJ. '� _........Foundation .... ..._.._ Prop, line ............. REPAIR/ADDITION(Prey. Sanitation Permit# ........w.................................. Date ... ....................... Septic Tank (Specify Requirements) .... ................ Disposal Field (Specify Requirements} .., -- -- -----• �' --_- .c. ---- ..------ . ----. ........... ....... . - ..........--..-.--------- ---------------- _........... (Drdw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be -dens in.accordance with San Joaquin County Ordinances,. State Laws, and Rules and (Regulations of the San Joaquin Local Health District. [dome 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 become subject to Workman's Compensation laws of California." Signed . ................ ............. . ... ---- -- Owner BY _..J:. -•------- Title ._(If other than owner) DEPARTMENT USE ONLY APPLICATION.ACCEPTED BY .. / - .-.- DATE BUILDING PERMIT ISSUED ..._ 1.. ---- -- -------------- --------- -- - --- DATE _ . ... . ADDIT L COMM ' -------------------------------------•------ ....._...----------- ._.. ....._.-..._.........---_. ...._...---- .---................ ----------------------............................ .- --._. ... - r .Final inspection by: _.._. -'.._ - - - - --- - - -------- -- ---� •- --------- -----------• --Date SAN JOAQUIN LOCAL, HEALTH DISTRICT . 13 E.H. 241-'AR Rpm_ SM - _... _.._. _. ... - 7 177.7 u