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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .......................•--........---...................= Permit No. a 1Complete in Triplicate) ---��...... -/6 .. This permit Expires 1 Year From Date Issued Issued 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: JOB ADDRESS/LOCATION . ... YL 1 ............,; /L CENSUS TRACT ................ ..... Owner's Name -----•-.... �.l ................... ..............Phone ........�-.....T...._z..--3-../.. ..... Address ................... c;2_ City ........................ ....... Contractor's Name ._-..`PL '._ - License # f �- pZ- Phone Installation will serve: Residence Apartment House C] Commercial❑Trailer Court ❑ Motel ❑Other...--•...................................... X Number of living units:.___-.`... Number of bedrooms l ..._Garbage a Grinder Lot Size •................. Water Supply: Public System and name ..............................................................................................�.............Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sand Loam /Cla Loam Y L�] Y ❑ Hardpan❑ Adobe 0 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: lNo 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 LINE ( ] No. of Lines ............. ----_ Length of each ,line---.....::_-................ Total Length ............................ 'D' Box ............ Type Filter Material ....................Depth Filter Material ................................ ............. Distance to nearest: Well ........................ Foundation ............... Property Line ......................... SEEPAGE PIT [ ] Depth -------------------- Diameter ........._ ..... Number ------------_ ....... Rock Filled Yes ❑ No 0 Water Table depth .-•---------------------------------------------Rock Size ............--.................. Distance to nearest: Well ........................................Foundation .................... Prop. Line ................... REPAIR/ADDITION IPrev. Sanitation Permit# -------- Date ................. Septic Tank (Specify Requirements) •••-•--•-••••................ -•................................................ .................. ---- Disposal Field )Specify Requirements) G (Draw existing and re uir(d addition on reverse sive} I hereby certify that ! have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health-District. Horne owner or )icon- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall net employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed -----------------------•-•------ - -_--•- - •• .......... . Owner ��,�J ,gam ---� -�- BY � 1L(". -QC(:.-- /1 _ .fit ........... Title A) f a .... (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTS© BY DATE . " 7 --._....- ................. ---------- ---------------- BUILDING PERMIT ISSUED ._ -----•----DATE ................ _.--- ADDITIONAL COMMENTS ..-----•- ---------•----------------- --------- -----------------------------------..................•--------. -------•-----•-•...... Final Inspection by, .-_ -_.-_4 --.._-- -._, - Date---- . .. EH 13 2}t 1-613 Rev. /- .� -------------- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M