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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT li lete i {Com -----..._.:-- pn Triplicate) ._ r mit _.... y r _ r - .,Permit ............. This Permit Expires f Year From Date Issued Data issued .?.:Za::T_7 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 County Ordinance No. 544 and existing Rules and Regulations: JOB ADDRESS/LOCA N ... ..........__....... ......CENSUS TRACT Owner's Name -. _ :..... . ....................... ................................. ..Phone ......... .. I Address ........ ../. C . . ._._.. - ... City Contractor's Name..__ -.-�c y-��... .................License lr. c a� . Phone ......... .................. Installation will serve: Residence Apartment House fl,Commercial ❑Trailer Court ❑ f `y Motel ❑Other ...................... Number of living units:__. Number of bedrooms .. Garbage Grinder `" Lot Size ..... ......._..._ ................................. Water Supply:Public System and name ...................................................... [�}� Character of soil to a depth of 3 fest: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay loam ❑ Hardpan Adobe Fill Material . ❑ ............ tf-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 ',fSEPTIC TANK f ] Size--- •- Liquid Depth Capacity __--- Type -•- •... Material....................... 1No. Compartments ..................... � •-- . . Distance.to nearest: Well ------------------------------------Foundation . Prop. Line ...._......:..........6 LEACHING LINE [ ] No. of Lines ................... .... Length of each line............................. Total Length S ................. 'D' Box ..___....... Type Filter Material ....................Dep#h Filter Material ............... •...................... Distance to'nearest: Well ........................ Foundation -....................... Property Line .................... SEEPAGE PIT "{ ) Depth .---•---__ Diameters...'_._:----- Number ............ Rock Filled Yea ❑ No ❑ Water Table Depth --•........ :..::............. Rock Size ...... ............... �O Distance to nearest-.:Well .................. ....................foundation .................... Prop. Line ....................... 'I REPAIR/ADDITION(Prev. Sanitation Permit/•` _._.............:: ......------_-..::..__ Date :. .--_..�.._ ............... I Septic Tank {Specify Requirements) ________________ t Disposal Field {Specify Requirements) ._.... - p ................. f ' - ;. --------------------- -------------------- •----•---•----• --------------.......... ---•------ - ----------------- .......................... .............. (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 3oagvitt j County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health,District. Home owner or )icon. 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 became subiect to Workman's Compensation .laws of Californla." Signed ..---------_----------- ---------------------- Owner By .............. •---------- � - Title -------•------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .....-.- -`--...----- PATE , .. : ., _ �. BUILDING PERMIT ISSUED _.:-- R"--- -_•------- -----_ ----DATE .....:.........•_ ADD#TiONAL COMMENTS ................................ .. .... . . .. ------ -------- ---- ------------__._.............................................. _ --------- ........•-------------- ------ . -- --------- N 'LOCAL HEALTH DISTRICT 8/7h 3M