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�1q • FOR OFFIC!»'l1SE: APPLICATION FOR SANITATION PERMIT �7 ' Permit No. /�.4?. .............................................. (Complete In Triplicate) .....................................................: -3. V �� 7Date issued ... .. .........................................•--.......... This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: jj CENSUS TRACT .... JOB ADDRESS/LOCATION 00 is _ .�_...-.�... Owner's Name L3� ...... ....._.._.. Address b••��- Oae :._....�.. .. City _....._ ?.. .�... .._. i ' .....License # cz �1`t�3 .._ Phone. -1� Contractor's Name .............•--. -•�'`-�'l' .. ............ .....__.. Installation will serve: Residence Q Apartment House'0 Commercial QTrailer Court]---- Motel Q Other ............................................ Number of living units:............ Number_ of bedrooms;...-..-----Garbage Grinder .--......... Lot Size .`..: ---":_ ......................... Water Supply: Public System and name........................ -------------. ....•----------•••--......-------.... .-, Private Q r Character of soil to a depth of 3 feet: Sand Silt Clay Q. Peat�._ Sandy Loam Q Clay,Loam Q " Hardpan E] Adobe'Q y Fill Material ........_.._ if es,type ...........................•••••••--..---• (Plot plan, showing size of lot, location of. system in ielotion to wells, buildings, etc. must.-be-ploced-on reverse .side.3 NEW INSTALLATION: (No septic tank or.seepage pit permitted if public sewer is available-within-200 feet;] S ' PACKAGE TREATMENT [ ] SEPTIC TANK[ ] . Size............-..........................--_- ..• Liquid Depth' ........................... l •.....................CaPacitY Type Material.. �....._..... No. Compartments s Distance to. nearest: Well ...Foundation ... ........... Prop. tine ._..._.......---•-••-• ' ....__. LEACHING UNE [ ] No. of Lines ... Length of each line...-................... Total Length ............................. r :._._.Depth Filter•Material ..._=t__. 'D' Box ----._... -- TYPe Filter Material .----...1... - Distance to neareStcWell .. Property kine Foundation,�....:................. ......-•---............_. SEEPAGE PIT [ ] Depth Diameter Number .............................. R _-. • Yes No Q _ _........ __, Rock Filled Water Table Depth .... ...-'_. .A.. r Rock Size --^------�---� .._. ..•Foundation ' Pro Line Distance to nearest: Well --�.............. --------••---......_ ....... .... 'REPAIR/ADDITION(Prev. Sanitation Permit #�� A• • � Date . Septic Tank JSpecify Requirements) .. 4 ................�.......- .............. ... �� .... ------------- ..................... Disposal Field (Specify Requirements) ------- ---------------....----- y .....:e .. � � ,�� x �� ,� _ - - -s+r`• �r.-G. -.tet ........... ........-.................... (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 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 iss�ed,l"shall-not employ aMr person in such manner as to become subject to Workman's Compensation laws of California." ISigned ...................... 11 ------ .-=--•-•-------.... .................. Owner BY { .... ................... . xitle (If of a than owner) ! ' FOR DEPARTMENT USE ONLY (' APPLICATION ACCEPTED BY r,�"/' A .........._ �� a4� 7/ xd _ ATS ...................... BUILDING PERMIT ISSUED D ADDITIONAL COMMENTS'.:.,ltl�t f .:. �4 f?�x^ :.T .. _f_ - - .....................................---•-..........--••---- -•-- :....::::::::::: : ..._ :::::::-::::• •----•.... ................._.__......---------•---•••••--------- ................... ----------------------------------- -. k Final Inspection b ------------------Date,] -----••---••--- G _SAN.SAN.JOAQUIN. LOCAL' HEALTH DISTRICT 7172 3 M