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.r FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ........ ................................. .... �.�_�' . II {complete in Triplicate) Permit No ....................................................`L.._. �I This Permit Expires i Year From Date Issued Data Issued :�..� . ` .............................. ...... r Application is hereby madle 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 LOCATI N ............... _.... .............._.......CENSUS TRACT .... ........ I / ....� tl..... _..Y - _. rte l . .v Owner's Name ....._. ...... :........- r!,!L Address ...� __ ... __.. te a"` .............. i ._....__......._..._................... City ' Contractor's Name _...License # h• .�.�-.-�.: .�:r._ Phone i Installation will serve: Residence 'Apartment House C❑ Commercial ❑Trailer Court r] Motel ❑Other ------...-•---------------------_---•----- Number of living units.. __/_..-. Number of bedrooms r- .___..Garbage GrindeLot Size ....__�� Water Supply: Public System and name ------� __-- ........ !^...............••--•--...............................Private ❑ Character of soil to a deptha of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam° Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ............ If yes.type ------_----------------— (Plot plan, showing size of lot, location ofsystem in relation to wells, buildings, etc. must be placed on reverse side.}Q NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) l SII' - M PACKAGE TREATMENT [ ] SEPTIC TANK) 51ze `.�....!�� ... Liquid Depth 41 ................ dl CapacitZ0i?_('. .:C_V_ Type Material.. No. Compartments ......4............. 6S - D'istance to nearest: Well ._/ --. .................Foundation ...Za. ........ Prop. Line _._. �....... ,. LEACHING LINE No. of Lines ------+2.............. Length of eachline...... ............. Total Length .._............ l7' Box .../---- Type Filter Material ./.IACE: ___..Depth Filter Material ... ..:................ ../.......:_._ k D�Ik tante to nearest: Well AIA-1,41 Foundation ...VXV__. ........... Property Line .. .............. F2LI°f Depth _,�r ..__.__._. Diameter v7 Number ..__...... ............. Rock Filled Yes �' No ❑ Water Table Depth ......... .......................Rock Size l Distance to nearest: Well Jkl ........._........Foundation ...za.--....... Prop. Line -%f................. REPAIR/ADDITION(Prev. nitatian Permit# ..................................... ------ Date .................................. I ' Septic Tank (Specify Re.!uirements i ) -----•------•---•---••-•.................................................................................__....__......._........._..... r Disposal Field (Specify.IRequirements) ....____.__. I� ... ........................... -•----------------------- ----- �f {Draw existing and required addition on reverse sidel kI hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin r County Ordinances, State'llLows, 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 perfo"mance of the work for which this permit is issued, 1 shall not employ any person in such manner os to become subject to Workman's Compensation laws of California." Signed ..__......._... . Owner ---------------------------- 3 ...... 'II• IBY • ............... Title ........ ....... -------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED I�BY ...........Cn/° G _.Zf/...... DATE ...... ... ...� .................. BUILDINGPERMIT ISSUED ..... : ..................... ...................-..............DATE ........................................... ADDITIONALCOMMENTS�..................•-•....._...............-----------------......._._.._...-------••......................---•--..._...............--•--••.._......------..... il. • _._ ....._..----•------....... ........... ....................... •--------------•----........--------...._._._................... . . .... h, . .. ............... .................. --..._...._.... FinalInspection by. . --- '...........................................•---------------------------------Date ----- ............. SAN JOAQUIN LOCAL HEALTH DISTRICT 13 24 7/723 - E. H_ 1-'GB Rev. 5M .