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FOR OFFJCE USE: ,D r� W APPLICATION FOR SANITATION PERMIT � 7,................ � - Permit No. .......... ------......•--........ (Complete In Triplicate) L...... This Permit Expires II Year From Date Issued Date Issued . Application is hereby made to theton 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 Jtules and Regulations: JOB ADDRESS/L CA ION .. _._. . . . .............................CE SUS TRACT .......................... Owner's Nam !` ...Piton -. .. ./;w.......... Address E t C7a. _04". Z Z City -- Contractor's Name k .. __ --- ------ ...---••---........License # ........................ Phone a_ . 8 Installation will serve: Residence NAP artment Hause E] Commercial OTrailer Court 0 Motel 0 Other....... ................................. Number of living units- )------- Number of bedrooms ___Garbage Grinder ............ Lot Size ............... .... .... ...... Water Supply:.Public System and name .............. Private Character of soil to a depth of 3 feet: Sand b Silt[] Clay ❑ Peat❑ Sandy Loom p Clay Loam, `Hardpan 0 Adobe V( 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 seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK ize-1A~k�� --------- -- ...I? Liquid Depth ........... Capacity .�'_R$7 e�...__ Type -- _ .. MateriaAW". _ No. Compartments ' r Distance.to i nearest: Well __7. 4...........................Foundation ...... .`�..._ Prop. Line ..........I........... 0 LEACHING LINE c< No. of Lines ----2--------------- Length of each line.__- ......._ ... Total length ................ 'D' Box -- +_._... Type Filter Material .. M. Depth "Filter Material ...-��l�.................�........ . ' D;'stance tonearest: Well _ .Q_.l.........-- Foundation .. f......... Property Line f ............ S#:EPAGE PIT 1 Depth ..�X-i--_-- Diameter ..S� ..... Number --- _ I --- ........ hock Filled Yes, ' No 0t Water Table Depth --------------•...............Rock Size ... ..;2...:?�..`�/..�F..._.. p � I Of- Distance to.nearest: Well -------/.............................Foundation ---2D....'.._. Prop. Line ......0..._.,_...Of... REPAIR/ADDITION(Prev. Sanitation`Permit# .....--.................•---•----............... Date .................................. I Septic Tank (Specify Requirements) ..................................••---------f-.....----------....---- ----•----... ..-----..................... •. ••.i --- Disposal Field (Specify Require + •----------------------------------------------------- -----._._.._.......--- ......•..................... ........................................-............... ......... --- __ ------:� (Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this application and that the work will be don In,accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health.Dlstrict. Home owner or licen- sed agents signature certifies the following: i "I certify that in the rformance of;the work for which this permit is issued, I shall not"employ any person in such manner i as to bec me subject to Workma s Compensation aws of California." Signed .... 3 id__,_.. _. - ,_'9 _ 1s0..--- �_--- ---..._.• t 147 By .............. { t ----� ,e Title �..,,:`. ......... .._..... If other than owner} FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --�--- --------.--------------•---:---_ DATE -`----.:BUILDING PERMIT ISSUED ------------- - ----_.DATE .......-- ----- "ADDI7lONAL COMMENTS 7 - ----- . ---------------------------------------------- = ' ------ ---- •-------. ------------ --------------- -- ----------. . --- - ------- --- ----------------------- . Final Inspection by . _ ..........................Date . .........EH . . .. 13 .24 1=68 lieu. 5m SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M