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............. POR ©FFICE USE: ] ....._..__.--------- +_ o APPLICATION FOR SANITATION PERMIT 1Complete in Triplicate) Permit. No ...... .............:......... .... This Permit Expires 1 Year from Date Issued Date Issued 3:3� �� 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 Caunty Ordinance No. 549 and ex ting Rules and Regulations: JOB ADDRESS/LOC ON C , ,��1'.• f l p f2�' /CENSUS TRACT R. _...._ i Owner's Name -- ��tJ..� ..._.....__.�L.L (� Q r /�e .......--• •......... .. Address ........ •...._._ City ...._ ----._._... _....•.......---- •-• ............ ��.. ...._ .. Contractor's Name .____-_- . ...... ..1..............License tl` � /� Phone C................ Installation will serve: Residence 0WP__0`rtment House 0 Commercial OTraller-Couit r .- r Motel ❑Other..:....... Number of living units:....... •- Number of bedrooms ..__...Garbage Grinder S�_C; .. Lot Sizej t Water Supply: Public System and name ............................................ I Character of soil to a depth of 3 feet: Sand Silt Clot r. ❑ ❑ Y ❑ Peat❑ Sandy Loam ❑ Clay Loam [I Hardpan [j Adobe I - pill M6terial�c7 If yes,type i (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must 6e placed on reverse slde.1*--.4 NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer is available within 200 feet,) t\ PACKAGE TREATMENT .f ] SEPTIC TANK t 3 Size................. ------..... _ ..... Liquid Depth .-------...... d ........ - t Capacity --- ------------- Type •.....__.... ------- Material...................... No. Compartments Distance.to nearest: Well, -..--------_----• .--•• ---._.. Foundation ................:..•-- Prop. Line ................. LEACHING LINE f ] No. of Lines --------------- -------- Length of each line..:................. ....... Total Length ............................ 'D' Box ........_--- Type Filter Material .....................Depth Filter Material ............ .. -"'- Distance to nearest: Well ........................ Foundation ............ ........ Property Line ........................ SEEPAGE PITDepth .-----•-- -- .. -- ---- Diameter .... .Number ----..........:............. Rock Filled Yes ❑ No C]� . [ ) Water Table Depth _________________________ ---------•---- -...._Rock Size _-�-- Distance to nearest: Well -----•-----••----_ --_-_---_-......Foundation .................... Prop. Line --.......... REPAIR/ADDITION(Prev. Sanitation Permit# ...............--------------------I ____ Date ._ j ,rte ---••-•------- Septic Tank (Specify Requirements) ...:------- . -------J-LJ_./....t........ Disposal Field (Specify Requirements) — - r •---- ---------- •.............•-- ....------•-•-•-......_. -------- ---- --- -- - - - -- ---------- - (Draw existing and required add It#on on reverse side# I hereby certify that I have prepared this application and that the work will be done in accordance with Son Joaquin j County Ordinances, State Laws, and Rules and Regulations of the 'San Joaquin Local Health_District. Home owner or licen- sed agents signature 5 g ure certifies the following- "I certify that in the performance of the work for which this permit is—'issued, I small not employ any person-in such manner as to become subject to Workman's Compensation laws of California." Signed --- ------ Owner b BY ............... � _ ._ ------- Title ....... ............... ll of an owner] - i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .... .. - DATE . .---. -- .- BUILDING PERMIT ISSUED . ADDITIONAL COMMENTS ..._..-•-•--__---- -- _ ------- ........ -.. .....:...DATE ....... ................................ __.._.._.._. . _ •-------..-----�- ----•-•- ---...-----•..................... --------- --------........................... Final ins ection b - - - p y: . ............. Date EH J_3 2� 1-6F3 rev. �M - r-. _... SAN JOAQUIN LOCAL HE TH DISTRICT s 8/7h 3M