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FOR OFFICE USE: ------ _ - ----•• APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. . - --------•- ---- This Permit Expires l 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 Ordinance No. 549 and existing Rules and Regulations: 'f/ p7 9 E JOB ADDRESS/LOCA N r � a ! � C� .......CENSUS TRACT _ -- ----- ... ._..---- Owner's Name ..... 1 ........ . ........ .. _..,......__..... ............. .. ...Phone ...� � z Address •"�-" . .T_ Contractor's Name --------------- y1�j ._.License t(b ?i. .. �i Phone ,_... -._.. �.�.. Installation will serve: Residence Apartment House El Commercial ]Trailer Court � Motel :... «� ❑other-------�.� �_.}.........__ � r �. Number of living units:..(.._._._ Number of bedrooms Garbage G{Inder at 1 �..� D •--x--.... ...... Water Supply: Public System and name ___-•..____•_ � -••---------•............................... _---••---.._..- ....Private Q - Character of soil to a depth Iof:3 feet. Sand❑ Silt 0 Cloy \i � ❑ PI' Sandy Loam,❑ Clay Loam ❑ Hardpan ❑°'"T"Adobe tX–Fill YNatertal ...�: '!#yea type............... ............ (Plot plan, showing size of lot, location of system in relation to wells,�building9, etc must be placed on reverse side.) NEW INSTALLATION: (No {No septic tank seed age pit permitted if public sewer Is available within 200 feet,! PACKAGE TREATMENT { I SEPTIC TAI�lK t Size.........................................•-..... Liquid Depth ..........................)J Capacity- I T e �... YP --------------- .... Material.�....-..�.----...... No. Compartments Distance to nearest: Well .:.Foundation Prop. Line LEACHING LINE ( l No. 00 of Lin;X, .. .. .` --:=--=--- Length of each line.___.._.........._. Total Length + , 'D' Box .._...-__. fype`Filter Material Depth! .Filter Material � Distance to nearest: Well . ~---~-.-Foundation "" •----_--- 1property Line ... SEEPAGE PIT Depth f Diameter Number .................... .... Rock Filled Yes ❑ No Water Table Depth .............................Rock Size ._.••--�•---•-- ...._ ` s Distance to nearest: Well---- - _ _--Foundation } Prop. Line ._ REPAIR/ADDITION lPrev. San ation Permit# ________,--_ � i ? Date .. Septic Tank (Specify Requirements) ------•.......... ._ ,. *. rti t.. --- T Disposal Field (Specify Requiremerits�)..I •"� - !r .................. --• ................. ...............: (Draw existing and required addition ori reverse side) I hereby certify that ! have,prepared this appiication and that the_work will be done in f County Ordinances State Law r accordance with San .!sequin I s, crud Rules and Regulations of the San Joaquin Local Hoa11K,District. Name owner or liven` u- sed agents signature certifies the following: �- "I certify that in the performance of the work for which this permit is issued 1 shall not employ on as to become subject to Workman's Compensation laws this California.,,ermitii p y y person in such manner Signed _.....------ { I ,-• , ----------- :_...... Owner •--•-------••---- SY •---------- Jitle _...._.. - (If other owner) .............. I FOR DEPARTMENT USE ONLY A4; IFiiii.iii. PPLICATIO-N ACCEPTED BYi._._._ _ ... _ a —'� DATE ... . .. .r --------- ------- ._ BUILDING PERMIT ISSUED ------ "------------- ` ------------- -------------- •-----_ ADDITIONAL COMMENTS . :.------ •--------.__DATE -•-------------------------------- ---- ..._--------•----------•------._ _------------ ---- i-•....-...__... ----------•---- ----------------- �!..� ► T., t tt ........................... _.. _ ._. - Final Inspection by: ............ .. ...... - - -•-•-Date ✓... __. .. SAN JC QU LOCAL HEALTH DISTRICT 6/7I1 3M