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FOR OFFICE USE: .A. APPLICATION FOR SANITATION PERMIT ....... ....... Permit No.,�7j.-.-- ' (Complete in Triplicate) ...................................................•••. ....... ................ ... ........ This Permit Expires 1 Year From Date issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein I described. This application is made in compliance with Co6hty Ordinance No. 549 and existing Rules and Regulations: ff ` JOB ADD RESS/LOCATIO ...(. f.. • ............................... . .-- -- � , �. _._ . .. ..__. CEN ........................... SUS TRACTr�p r___,. .,... .==Phone Phone 9.�1 ....... ..../ Owner's Name ..................................... •• Vii-... _..........---•-•• ... .. Address ..............j -. .dT.. ....... ..... City .. . . .. Contractor's Name w . ---- � -7:...... License # �,Sfl�-��. Phone 4 Installation will serve: ` "" ,Residence {Apartment Housefl Com-r6ercial ❑Trailer Court 0 MotelC]Other .............. .....................• J Number of Living units:_._...(..___ Number of bedrooms ........____Garbage Grinder ------------ Lot Size ....... Water Supply: Public System and name ------- .............. j ......................._.._..............................---......................Private Character of soil to a depth of 3 feet: Sand 0 Slit l] Clay ❑ " Peat❑ _ Sandy Loam ❑ Clay loam Hardpan ❑ Adobe Fill Material ..._______-_ If �type a ......................... . Y (Plot plan, showing size of lot, location.c4 system,in` relation to wells, buildings, etc. must be placed on reverse side.) - NEW INSTALLATION: (No septic tank or seepage pi# permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ) SEPTIC TANK ] Size:............................................... ,Liquid Depth .._....................... Capacity .................... Type ._....,.........:... Material----------............ No. ' Compartments .................... Distance to nearest: Well ....Foundation ..`r` -Prop. Line .............: LEACHING LINE No. of Lines ` Length of each line...--------_ Total Length 00 go 'D' Box ............ Type Filter Material ..............:.....Depth Filter Material ......_.._......._._...._. ................. Distance to nearest: Wel( ........................ Foundation _`_..._.......... Property Line SEEPAGE PIT [ ) Depth Diameter ................ Numb$r- ............ Rock Filled Yes ❑ No ❑ . . .:;..__...:.Rock Size Water Table Depth ", ..............•.......--.a....--- Distance to nearest: Well ....... .............................. =Foundation ...._.__...... .:... Prop. Line ...................... : REPAIR/ADDITION(Prev. Sanitation Permit# _........-.--------------------------------- Date ................................... 3 Septic Tank (Specify Requirementsl .......•-----------_..______ _ ____•_....�......._ Disposal Field (Specify Requirements) �(, ._.._• ,�� rrC! s...• - ............................. ....................... ----------------------•--------------------- ---------........----.....---------•-•--•-••-----...---•---- ------•-•••••-• (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 Health District. Home owner or licen- sed agents signature certifies the fall owing:,•.. I certify that in the performance of the wark'•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." f _ Signed ..................... .. .... �.. Owner By ........... .. ---••------ ------ Title ...... .... .. . (If of thanrowned_V _ I T_ _DW FOR PEP RTMENT US ' APPLICATION ACCEPTED B A. = •--------••---•--J ........:...------•-•-- .. DATE ...�. ......y...7� BUILDING. PERMIT ISSUED ....................•--•.................----------•---•--••---....------------------.._.............---_•DATE ......................... ...... ...... ADDITIONAL COMMENTS ---•.........................•-.......---............---•........._.... .................-.........................-......... ............................................ ............................... ._....................... ..... ------- ------ ---- ------------ -------- -. .. 4Y i Final Inspection by: ...:..... t . ................ .. - ,.:::................ .Date .._......._ - .�•. ,. , -tic; SAN J QUIN -LOCAL HEALTH DISTRICT E. H.1-3 241-'b8 Rev. 5M 7172 3 M