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FOR OFFICE USE: FOR OFFICE USE.: APPLICATION FOR SANITATION PERMIT p` ' -----------•--- •---........_.. ........ . ....... (Complete in Triplicate) Permit No...�._-._.-- -------•---------------- - ------ -------- Date Issued •••••-•••••-••------.................................... This Permit Expires i Year From Date Issued t 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.. 0-04._Hl � 4� CENSUS TRACT---------- ------- - �-� Owner's Name.............: - - ------------•-----------.Phone--P�---- .... ......... Address-------------- -- - �-; ]r �1L ..-1..=c City.../ c'•.... -- --Zip-�� 5k----y------ Contractor's Name..........___...-. . '�] License # 3 �... _-. .Phone___ .-..-- ! Installation will serve: Residence tK Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other-- .......... ---:.. ,. Number of living units:..... ..........Number of bedrooms.--r Garbage Grinder---..---.---Lot Size---- ... d.......-_............ -- Water Supply: Public System and name---- - .- ..................... -•-----• ............... ' ----....Private Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Pelat ❑ Sandy Loam Clay,-Loam Hardpan ❑ Adobe'❑ Fill Material "If yes, type------------------------- (Plot plan, showing size of lot, location ofsystemin relation to wells,,buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank for seepage pit permitted if,public sewer is available within 200 feet,) PACKAGE TREATMENr t` ( } SEPTIC TANK �i.ize.......... 14 -- Liquid Depth �FMate•�ial._•:-�� No. Co%partments.-- �" .............:-----TYpe--- - , Col-��:-,---�----r--� ! r C3 Distance to nearest: Well------...,. -. ..----...foundation------..1 D-_.........Prop. Line..-...•--------------------- _ LINE r�T -:No...o.f Lines__ 21.- ._....Len th f ea h line,.:— y:/.� Total Length . `6�''-------- LEACHING - ,• [r 'D' Sox--.-' . Type Filter Material..--�.rDepth`Pilfer Material............... ..$-.---.....-....................._._.... r t � r Distance to nearest: Well.... .._. __..-.Founds#ion".:----_...---�-------- Property Liffe-_.. `.-'`- : J ,. . .. -- SEEPAGE PIT { } Depth------------ ---Diameter--------------------Number------------------------.---.--- Rock Filled Yes ❑ No 'I Water Table Depth------------------------ �..... ------....i.---Rock Size---------- -- -------------------••--••-- r Distance to nearest: Well. -- -...-- _....Foundation.-.:. .........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 done in accordance with San Joaquin County Ordinances, State Laws; and Rules and Regulations of the San Joaquin Local Health District, Home owner or licensed 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 Idws"of Ccilifornia�." Signed---.----.. ------- -------------------------.... ...... Owner By----------------------- - ---------- -- -•--- Title..... ........ ther than owner) FO DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--...... ---.--...DATE .----.-- DIVISION OF LAND NUMBER............... . ----------- ......_DATE----------------------------- ADDITIONAL COMMENTS............... ........................-.......................--- --..... ' --------------------------- -- ------------- - --------------------......----.'---. ------ ...-. . ------------.................. ..............----------- ------------- .---...---- ........... -------•--•-•---•---- -- - ----- ------ - ---- --- ------- .... ....-. .. - Final Inspection b .............................................. Date. .....-- EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT Pas zia�� eev