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FOR OFFICE USE` APP!lCATfQM FOR SANITATION PERMIT................. ...................................... Permit No. ..... ..�.:.-.�3�' (Complete In Triplicate) ....................................................... Date Issued ......................................................... This Permit Expires I Year From Date Issued Application It 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 complianc with County Ordinance No. 549 and existing Rules and Regulatlons: Qm JOB ADDRESS/LOCATION .. �J'� �. Y `� ��-....,,.....CENSUS TRACT ... 6 . . � ..... ..... ........... i. ... p _...... ................ Owner's Name ........I......... � ...... .................... ... .......... .i. ............Phone Address ---------• ..._ .. ._.. _ CNy4. ...................................................... Contradar's Name _.-.... _....L . --c._. :..._ _--__..._ ........`.. ........License # ........................ Phone .............................. Installation will serve: Residence jdApartment House C] Commercial❑TrallerCourt ❑ Motel❑Other......... .............. ..........••-•. Number of living units,......!---- Number of bedrooms . ..Garbage Grinder _._......_- Lot Size .=:-�:.. ............... Water Supply: Public System and name .................................._..................... ..................................................Privatq Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam❑ day Loam Hardpan❑ Adobe j( Fill Material............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 j Size.................................................. Liquid Depth ................._........ Capacity ....... Type .. Material..................... No. Compartments ' Distance to nearest: Well ....................................Foundation....................... Prop. Line .................... LEACHING 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 tine ....................... SEEP [ ! Depth .................... Diameter ................ Number ............................ Rock Filled Yes ❑ No i❑ Water Table Depth ................................................Rock Size ................................ ` Distance to nearest: Well .............Foundation ... Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit ...................... Date .................................. ! Septic Tank {Specify Requirements) ........ .�a� --- -•--- ...... Dis oral l=iel�Ci (specify R menta). ; .......... . . .. ..:.. . .... f .. . ..`.' .`..... .............. ...... ... ..............� .............................. ..... ... .....--•...................................................................................................._........_................_.................................................................. (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 taws, and Rules and Regulations of the San Joaquin Local Health District. Hem* owner or licen- sed agents signature certifies the following: "I certify that,In the pedormance of the work for which this permit Is Issued, I shall net employ any person In such manner as to beco ee subject to or man's�Compens on laws z California.'. Signed .. N...' ..:...f...._..QJt..�c�-�'.. •r-d er- �y ................... . -- -•--•... e - ............................._.-----_ lif other than owner) ry 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ..................................................................... DATE ...... - ...71 .: ......-: BUILDING PERMIT ISSUED ........DATE ........................................... ADDITIONAL COMMENTS - .... ......................................._.................----. ..,_•.........lw �... I.��.. .�........ ...... �� a........ .......... .......................... ............. ._.......,..... Final Inspection by: ............... �.7�..��'.-- -.......................•....._._. .. . . . .. ....Date ....... .?�.?i 13 24 -bt} Nov• SAN JOAQUIN LOCAL HEAdTh DISTRICT 8 711