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FOR OFFICE USE. ......:..-............................. APPLICATION FOR _SANITATION PERMIT �,,� (Complete In Triplicate) Permit No. ... -'-' •• This Permit Expires f Y"r From Date Issued Date Issued ... / - Application is hereby made to the San Joaquin Local Health District for described. This application is made a permit to£construct and install the work herein i nce with unty Ordinance No. 544 and existing Rules and Regulations. ' JOB ADDRESS/LOCAT N Owner's Name`.. ,/.,f7�. _?11"._ = ::/' - ... ...............CENSUS TRACT ..___...^..__._..... :_ _ / f-' Phone Address ,.._..... • 4��7 •�.1•...................... city Contractor' --•-.__ ..........:....................:.................... Contractor's Name !J .... License #-� ,9. Phone ,f Installation will serve; " Residence + E3-Apartment House Commercial ❑Trailer Court' a` Motel[]Qther :...._.. s Number of .living-units:.......)_ Number of bedrooms ......Garbage Grinder lot Size ./ Z -_.__.. -- o?,� Water Supply: Public System and name X` •"•••••••_-• ---•••---- Character of soil to a depth of 3 feet: Sand 0 Silt Cla- Pn �— . - 'vote ❑ Y ❑ Peat EJ Sandy Loam ❑ :Clay Loam [] } Hardpan [] Adobe dfes Ye ............................. + (Plot plan, showing size Of-lot., location_.of_system_.in.relation-to wells,-buildings, etc, must be'placed on reverse side.) NEW INSTALLATION: {Na septic tank or see age t permitted If public sewer is available within•200 feet P g Pi / ,1._. l PACKAGE TREATMENT p [,� + SEPTIC TANK�� / -- 1 .. iae___. .. eY.S',el -. Liquid Depth .7___Xz,_........... Capacity -/- fl: / Z TYpe -...-•---:._ Materiah_ No. Compartments --•---•- Distance to nearest: Well ._..,�f� •1 `••••..•.... ....Foundation ..,_Q ........... Pro Line LEACHING LINE [i��No. of Lines _- p' - __ ,Length - > - ------------•. gth of each line ...... Total Len th J � • 'D' •Box - . /_ -/-��_...R......__. Type Filter Material�ft..,&.......Dept Filter material---/ "• --•-•••..•_........._ P Dist an to nearest:Well/" - •-t"�•�•-�•~ � / •"• -� Foundation Property SEEPAGE PIT j:� De th Line ............0 —----, p -- , Diameter � Number Rock Filled Yes [ �,� " - - _ j o Water Table Depth ___.. •-•,• ----Rock Size . r Distance to nearest: Well ...1--_ .•`•_•_ --_--___ Foundation ... � t__..._ Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# ••_"'- -•-•-•••--•---•••••-------•---• Date 1 1 Septic Tank (Specify Requirements)-`-.............. Iy ......---•..-..._.--- -•---•• Disposal Field (Specify ......................._....._---.•-•-.. ' ( p Itequir..ements} ••••••••_•••__ - - �'�^ .................... ....................... r (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 H sed agents signature certifies the following: ealth District. Nome owner or liven- "I certify that in the performance of the work for which this permit is issued, i shall not em an ? as to become subject to Workman's Compensation,laws of California.,, ploy Y person in such manner Signed ......I---- ,.. Owner By ........................ . . ...... . ._ _ ,,�� (I o er than owner} } --..:, Title _.._ d',/j.. ov FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY... BUILDING PERMIT ISSUED .:........... . •• .....--- - DATE .........` 13 ... ADDITIONAL COMMENTS DATE ................••---...-••-•• = ....-••••••-••...... .......--••............. .. -•----•-•- ----••-...--••............... -........_ _ ._.. -•-._.... -•-.... Final Inspection by ___.... ..........................I...... .............................. ote --•__________________•---•-••••- .•..••........................Date _ .SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.