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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT •- ------••--- Permit No. . .. (Complete to Triplicate) ......._..3......9..3 .......................................................... _ ...... This Permit Expires 1 Year From bats Issued Date Issued ...�./.. �..r 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 complion with Co my Ordinan o. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION T .. ,�1 .. ...... .. ......CENSUS TRACT Owner's Name . ,..... n- ......................................•------.....................Phone ....,....-................... Address ................ Contractor's Name / �� .. {� License #1..3,V 1..1. Phone .�..��.�o—. .I-k7 Installation will serve: t Residence[44cpartment House Commercial E]Traller Court I] Motel ❑Other............................................ Number of living units:-..f -y. Number of bedrooms ...,.1....Garbage Grinder .._......... Lot Size .f.. .......... Water Supply: Public System and name .....------•---•.........................................-----......_..........................................Private Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam fl Clay Loam U]-- Hardpan ^Hardpan❑ Adobe❑ 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 vailable within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK[ ] Size.-._w�'„.... .... - quid Depth .. .................�- Capacity494- . Type .................... Material.. No. Compartments _.-,9............. � Distance. to nearest: Well ....................................Foundation ...................... Prop. Line ..... ...............0 LEACHING LINE [ ] No. of Lines ..--- ------- - length of each line........ ............ Total Length _ 6.10 'D' Box I....... Type Filter Maters ....................Depth Filter Material .49................................. Distance to nearest: Well _. .. .......__ Foundation ... Property Line 0.............. SEEPAGE PIT [ ) Depth . .. Diameter ................ Number ...- ._.-............------ Filled Yes g1-1 No 0 Water Table Depth ....................... Rock Size-- -------------- Distance to nearest: Well ..�_ .__�.......................f=oundation _..._._...._........ Prop. Line ...................... REPAIR/ADDITION(Prev, Sanitation Permit# ...........-----------------------------.... Date .................................. Septic Tank (Specify Requirements) ..........- Disposal Field (Specify Requirements) ............. ..............------------------------•-------••--------------...-....------------------•.......... --................-.......••.................................................................. (Draw existing and required addition on reverse side) I hereby certify that i have prepared this application and that the work will be dons 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: "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 s++ ct to W rkmanl �peosawloof California." Signed r- . ...__ Owner BY ----- ----------------------- ------------.. _........ title ......... . (if other than owner) _ FOR DE ARTMENT USE ONLY APPLICATION ACCEPTED D BY e-- - .. . .--�---�---- ---•---- --------------..........•-• DA7I? Z�.. .............-- BUILDING PERMIT ISSUED ...................... . • - - --•--------------- -------- .............--....... .__--.DATE .......................................... ADDITIONAL COMMENTS .--•---•.......................... .................................................. ......... ... ..........-------- ------------r--•-----••--•- -.._.. Final Inspection by: ...... ...... . . -----••-•-•------I--------- ......----------•-....... --- - - Date � � ................... --- EH 13 + 2a -bFi lav• SAN J QUIN LOCAL HEALTH DISTRICT 8/7h 3M i