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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT _....._.. Permit No_?....... .. .. (Complete in Triplicate) :......_............................ .............. ...... This Permit Expires ] 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 described. This application is made In compliance with County Ordinor#ce No. 549 and existing Rules and Regulations: 4 _ JOB ADDRESS/LOC TION, _... �� : ...........................CENSUS TRACT .>.... :::...._..... Owner's Name . . T --- a ........I. ..Phone .� ..:,11<2/0.:_... Address -------------------- �� . ... . .......4 ................icity ... .................._..................__•......... Contractor's Name .............. ..........:.... .. --..............,..License f } ..... Phone Installation will serve: 'Residence ]Apartment House❑ Commercial❑Trailer Court ❑ d Motel ❑Other ............................................ Number of living units:.__.f_1_f�lu_rriber:of bedrooms_, __Garbage Grinder .. _...lot Size ..f ��p_ Water Supply: Public System and name .................................................. ... .._...........Private [ �� Character of soil to a deLth of 3 feet: Sand'❑ Silt❑ -Clay ❑ Peat� Sandy Loam 0 Clay Loam 17 �--- �----- -�-Hard an -Adobe Fill-Material _i If yes, type ------------------------•-•- P � f (Plot plan, showing size of lot, location of. system in relation torwells, buildings, etc, must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage it permitted If public sewer is available within 20 p P f l' e 0 feet,) PACKAGE TREATMENT { )—SEPTIC TANK �- —Siaert.=? ... ...1 `M.--- liquid Depth Capacity ._................. Type ........... Materia!'-- --- !-�+-.._. No. Compartments ...................... - Distance to nearest- Well •-•-... ---. 0u�datib1 ................... Prop. Line ..................... LEACHING LINE ( j No....of Lines..-_�` -` -. - g .:. .............Len th..ofreach"'line.--�`.�-..��-----.._... Total length .......................... D' Box ........... Type Filter Materia! ____. ......Depth Filter Material+..........................::............:... ,Distance to nearest: Well ....................`:!:XFaundation Property Line ..._.....-_..., ._....:. 1 SEEPAGE PIT ( ] Depth ..............rr.� 'Diameter ._- • - Number ............................ RockAFilled Yes ❑ No 'Water Table Depth ` .. .--- ... Rock Size .............. -� istance to nearest: Well .. ..__..!_ 4 - Foundation .................... Prop. Line ....................... ..... REPAIR/ADDITION(Prev..Sanitation Permit s'# :..... ......... ... ..: -..._ Date _-..___ ____............._.. --• r / Septic Tank {Specify Requirements) .... ....E . ...... .•_.. Disposal Field5 ecif- Re ulrements) l: 'G�1�9-----? -- .y I -- -----'._............... --------..' ••- ... ----- ------?........... ................. i {Draw existing and required addition on reverse side) I hereby certify that I h ve prepa'redwtt,is aspll`cafion"aisd'fhat`fiie work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Healtf District. Home owner or licew sed agents signature certifies the following: I I "I certify that in the performance of the work for which this permit is Issued, I shall not empioy any person in such manner as to become subject to Workman's Compensation laws of California." 1 # Signed I _.. -- ner BY ---- •......... .. . .. ...... ...... .. -- --------------- -_--._....-----------•. Title ------- --- -----. '........... _...:.._...:.:. (If he t an owner)] FOR DEPARTMENT USE ONLY a APPLICATION ACCEP D BY •----/V - ---- •-•••- ............... ............. > ....... DATE ._. ._. ............... BUILDING PERMIT ISSUED __.._.....:�''_ _____________ f. '� ADDITIONAL COMMENTS ' Q/ i /� is�.a:�._._ /-/, 1 ........._: A ��. '..:.................. .... . :.: ...............•••--......... .� --.:.... _ ..........................., Final Inspection by: ........................... ....................... .......:.... ate ... I; : f : . ,�_SAN':JOAQUIN LOCAL HEALTH DISTRICT",, � t y 7172 3.rt E. H.13 241.'66 Rev. 5M