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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7S' ..• (Complete in Triplicate) Permit No. . ...........•....L. .......................••....................... 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 f described. This application is made In compliance withCounty Ordinance No'. 544 and existing Rules and Regulations: JOB ADDRESS/LOCATiO .L. i ./.---...' ..CENSUS TRACT Owner's Name .... - .. ��_ .l........ .' :;.i.... �. _ :.. �� f " ....... Address .............�a��z�. .�' �'�-. f.7.Ea��.rr_ . ._ ,.. - --• one ........---•......._........_....... `....� -- ••--- -•-•--.... City . .. ....................... ..... Contractor's Name ....... ._• - -. � �. A_. License # .fgy ----...._.. : Phone .................. Installation will serve: Residence [TAAportment House❑ Commercial pTrciller Court Motel " ❑Other ...................... .� Number of living` units:..... Number of bedrooms .....y.Garbage.Grinder ............. Lot Size ...................: --=L� Water Supply. Public System and name .................. .... . s - ....... - Private als Character of soil to a depth of 3 feet: Sand .. ❑ Silt❑ clay ❑ Peat[} Sandy Loam Clay Loam (] Hardpan ❑ Adobe Fill Material .•..__.....- If yes,type .................... .............. (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,seepage pit permitted if public sewer is available within 200 feet,l PACKAGE TREATMENT ] . SEPTIC TANK f3 size................ •-••-•---- ..... Liquid Depth Capacity .................. Type •-•--••------....._ Material...._....._... .... No. Compartments - Distance to nearest: Well ................... Foundation . . ......_...--• Prop. Line . LEACHING LINE ( ) Na. of Lines :..-_---•. Length of each line....... .....:....._........ 'total Length 'D' Box Type Filter Material ......................Depth Filter Materialg # .. `' � :.�..�, .. --------------•-•-•---------._...._--•----- Distance to nearest: Well _----- ==== ..`Foundation r Property Line ............... SEEPAGE PIT [ j Depth ..:_. Diameter Number — .............. --•�........••-• . Rock Filled Yes [] No Water Table Depth ----------------------Rock Size I Distance to nearest: Well Foundation s ................................ Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit�# f - . Date -� Septic,Tank (Specify Requirements) .................................. .......... _................................. Disposal' Fi Id {Specif Re uirements Y g I _.. �_. _.. --------------------------,`� . •-------------------- ---- Min {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. Horne owner or licen- sed agents signature certifies the following: 1/I certifythat in the - 4 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 ......................................................: ...•- ..Title Owner By ............................................•--•-..:.:._....__. r� `�.. (If other than owner) A .._...........................::...... FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . BUILDING PERMIT ISSUED --... ---------------... ---... ••------•••....I...... --------... -... ... ... . DATE--- ,� 2. .I..... .. ................................. ._.._.I...... . .......----••-----........_....... .....--- DATE ADDITIONAL COMMENTS .. ....I.......... ... --...---------....._...... ....:........:•••-------....--•---......-•--. - ------------- ........-----••-•--•------••-- -----•--........--•---•--- ' _. ..... -----------------••--•-------•---....----....... .............. ' ...-•-•------- ---• . Final Inspection by: .._....... 7jT1 '••-_...--.... = ................... r �` ... ._ Date !' . R _ SAN JOAQUIN -.LOCAL HEALTH DISTRICT ` E. H.1.3 241-'b8 Rev. 5M �..� . .. ... .. .�