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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT C` G (Complete in Triplicate) Permit No. . Z..:.. l �r . ..............I.................... This Permit Expires 1 Year From Dote Issued 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 mode in compliance County Ordinance No. 549 and existing Rules and Regulations.- JOB` / � � ADDRESS/LOCA N ........CENSUS TRACT i q. Owner's Name .. .. . .... ..... . . . . . .......( •. --•- ......,....::. ..................Phone . .V............... ........... a � .�y�. Address .-•-` �. r........ .......... ....................... .... ... e--.....City ...... .. a..._..- Contractor's Name .- ice .. xre License # Phone •---•....................•--------•---...-•-- ... Installation will serve: Residence ❑Apartment House Commercial ❑Trailer Court `v Motel ❑Other ......... fl?eb/Ca Number of living units ---- Number of bedrooms _.......Garbage Grinder " '..�.. Lot Size Water Supply: Public System and name :............. ..'�vie.z�.................Private Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat C] Sandy Loam f f'Clay Loam ❑ Hardpan[ Adobe l] 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.) f NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK [ ] Size.___./9.e. .............................. Liquid Depth ........................ .. Capacity .. Materiale�ir�P�No. ortments .-. Cam �..;.:.... p Y�ZO.C''.......-- Type ..:............... p Distance to nearest: Well .. ...._..Foundation .......... Prop. Line LEACHING LINEN'o. of Lines ! ( ] .....�................ Length of each line.---�.-_......... Tata) Length ....... 'D' Box Type Filter Materia i' c Depth Filter Material Distance to nearest: Well �LQQ............. ountiation ......... Property Line ..'5__:i .. .......... SEEPAGE PIT [ ) iDe,,, h . ..._.. Diam er ........ ...... Nu ber ..._..... .._.............. R Filled es ❑' . .No er ab ock Size ...ce t ne est: Well ........... .................. .......Fo ndotion ....... ........... Prop. Line -_...._ ..----_._ --- REPAIR/ADDITION(Prev. Sanitation Permit ............................................ Date J Septic Tank (Specify Requirementsl .........................._............................................................................................... Disposal. Field (Specify Requirements) ------------------------------------ ........................................... ......................I.............. -------------•----•----- ._--- (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 issued, i shall not employ any person in such manner as to barolett to Workma ''s C Pe on laws of California." o Signed .. ..... . •----- --------. Owner By ............................................ ........................................................... Title ----..._.......--------....._...._ ..................................... (If other than owner) F R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _____-• •--_-.._ . ......... ........ ...................... DATE . _-��• .7�_----_---_ BUILDING PERMIT ISSUED ................................................ .............. ...... . .-------------------.----- -- ---- -.....................DATE :.......---..::.. ._ ADDITIONAL COMMENTS ._.......I........... ......•.................................... --.... ....... =- ------------------------ ----------•---....... ......�....... .......----- ........ Fin.....:_.. -- ----•• ............................�---------...._............--••-----............... - Final inspection by. .......�a , ....Date SAN JOAQUIN LOCAL HEALTH DISTRICT 7 I 9G .,.. .. . .. 7 171 Z .0