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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Triplicate) ---__ .......................................•__::........_..... Date Issued .j' � 7� This Permit fxpires'I Year from Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construd and install the work herein described. This application is made in compliance with County Or finance No. 549 and existing Rules and Regulations: , JOB ADDRESS/LOCATION. ......l..I��.. v ...........CENSUS TRAGI .......................... Owner's Name -- .. ._1.�✓-!_-•....... ...... ......• ................. ...............Phone _................................. //// Address .---- ..............f{ . ......... --•--••'•• ...... City .......................... ................................................ Contractor's Name --------- «...._ --- ......... .... .......License # 2.1.,x. 1`... Phone 4."..v1,J._-5r G.ZZ Installation will serve: Residence GA-P-0-rtment Housef] Commercial ❑Frailer Court C] Motel ❑Other ----- Number of living units:.._..1..... Number of bedrooms . .....Garbage Gr#rider�;1... tot Size _. Water Supply: Public System and name ........... .....Private ...-....---•-----•--.....--------------•.._..._..-.....-------.............i�__....._.. .. Pr❑to -' Character of.soil to a depth of 3 feet: Sand b Silt❑ Clay ❑ Peat Sandy Loam ClayLoam Hardpan ❑ Adobe o. Fill Mater' .--._... 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.._.._........----------------------.......... Liquid Depth --------•---.............. ! Capacity -----• Type -------------------- Material..................--- No. Compartments ...................... Distance to nearest: Well .................................•..Foundation ...................... Prop. Line ................... LEACHING G LINE [ j No. of lines ------------------------ Length of each line---.--..-.......-.....-•---- Total Length ........ .................. 'D' Box ............ Type Filter Material ----------..........Depth .Filter Material _--•........................................ Distance to nearest: Well ........ --------------- Foundation Property Lisle .......................i;l I SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ....................:....... Rock Filled Yes ❑ No I� Water Table Depth .............................................---Rock Size ..._............. ....... Distance to nearest: Well ........................................Foundation -------------------- Prop. Line ..................... .,� REPAIR/ADDITION(Prey. Sanitation Permit# ............................................ Date ................... _:______..-..) Septic Tank (Specify Requirements).__-:. - ----------- - Disposal Field (Specify Requiremen s) ................. -•---•--•- - '`��` - ..... -•---...-•--•-.: ....... ........ - 1.0- -,.. ..---••----•... ........................ ------------- ------------7 ---------------------------------------------------••---------- -------------............................................................................................. (Draw existing and required addition on reverse side) f I hereby certify.that I have prepared this application and that the work will be done in accordance with San Joaquin I 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 %hail not employ any person in such manner as to become subject to Workman's Compensation laws of California." i Signed ------------------ -------------- Owner X_ _" By - /, Title �f .. ........ GSL/ ( t er than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ....xfDATE_..3a..�3"..�. .....:. BUILDINGPERMIT ISSUED ........ ----•--- ----------------------•--------------.....---------------••-- ------..DATE ... ----.........---•-•---------•----•----- I ADDITIONAL COMMENTS ---------- --------------------------- ...... _..... ----------------- Fina! inspection by: .. f-- ---- ...........................Date ...3..�.. - . ................ EH 13 2 1-6 mow• /--.N JOAQUIN LOCAL HEALTH DISTRICT 874 jH