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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - -------- — lComplete in Triplicate) Permit No. .............. ..... ........ This Permit Expires 1 Year From Date Issued Date Issued . .. ...7.3.... 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 County Ordinance No..549 and existing Rules and Regulations. JOB ADDRESS/LOCATION . . . .. . i .............CENSUS TRACT .....----f---r...._....._ Owner's Name ....... - _..---- - '"''.' ..� . C .� e%"..... Phone _ Address pi.. _. : . --- --�..-----. ..-.-----��-( -----.. City -� ----------------•-.--........_..._._.... Contractor's Name Phone ` '�'� Installation will serve: ResidencericApartment House[] Commercial ❑Trailer Court C] Motel ❑ Other ....... .................................... Number of living units:_. .. _.-Number of bedro ms ---*.__.__Garbage Grinder '" .. Lot Size _.. ................. t Water Supply: Public System and name ....... _..-__--- --- -•- --....---•--•--- ----------Private�K_ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ AdobeX 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 / Size._.,1. �..��.._., �r - .-._. Liquid Depth _.. �. .................. J Capacity/, �.... Type T.."� P-� Material.. -� �GdNo. Compartments .._�`-- N I` r r � T Distance to nearest. Wel! .. . ��:...................Foundation ...,Z............. Prop. line _4............... 3 LEACHING LINE K11" No. of Lines ._. _._. _. .. Length of each iine.....:..... Total Length •.12r�:_....._:_. - D' Box Type Filter Material C '.._.._Depth Filter Material _... ..................... :. Distance to nearest: Well .5....._............. Foundation .l`�..-.........._ Property Line -_:�►�. ..... SEEPAGE PIT _ r r _ Depth Diameter �.�____. . Number ........... Rock Filled Yes � No [} 7 Water Table Depth ......... �............... ..Bock Size .... _ ------------ Distance to nearest: Well ._..____.._._._. --- _;;_..._ Prop. Line ..:. .. ............. . REPAIR/ADDITION{Prev. Sanitation Permit# ..._.... ..................._............_ Date ___.._.__-.._____---------___-.-__l jSeptic Tank (Specify Requirements) ... . ............. .....................------ ----.---------...... . , Disposal Field (Specify Requirements) ............ .. .. ............. ...... --------------------..................... ... .............. _-...._------------- I' ...............................................................,.._............. ................. .................. - _......... ..... .. ........................................... ------- ------------ ................ (Draw existing and required addition on reverse side) + 1 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 Health District. Home 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 subject to Workman's Compensation laws of California." Signed .:................... . Owner By .... .... ... ......... . . . �:�-�:...---..��._ ��.__._..-.---._...._ Title I (if other than owner) FOR P TMENT USE MLY APPLICATION ACCEPTED BY ,....... . V DATE ..... ��-- --3.................. BUILDING PERMIT. ISSUED ... _ .. fDATE . . _....... .........,__....•........ ADDITIONAL COMMENTS ... . . . --- ---•--- -- -------- --- -- -- --•----...------.... .............................................. . ....................----------- .. ----- .. . ------ .........--_..... .......................................... --------•-------------- - -------.. -------- . .. Final Inspection by: _ .._ ; : .----- ..........................Date ....Z:-=/,-3. SAN JOAQUIN LOCAL HEALTH DISTRICT '