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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT w :.:.................................... � Permit No. ..4- - -......_ (Complete in Triplicate) ............ I� Date issued ........................................................ This Permit Expires 1 Year From Date Issued i1 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 IE Regulations.- ..... /. . ... ........ ......CENSUS TRACT ._. . JOB ADDRESS/LOCATI N .i . ....Phone Owner's Name . Address ...1 .._._._.-. ... Cir c. _...: --..., City - —1 ....: Contractor'rs Name ..... ........... ....License # .«� Phone ... ... 4 Installation' will serve: Residence-Cl-Apartment House G-�Commercial-❑Trailer Court 0 Motel ❑Other __77 ----- - -------- Number of living units— Number of bedrooms ............Garbage Grinder ..____.... Lot Size ..._.. ?—y•••:••-••• II 1 = --••Private Water Supply: Public System and name ....................--------------•----- ------------_...._ t 8 Character of soil to a depth of',3 feet: Sand Silt[] Clay ❑ Peat❑ Sandy Loom { ]� lay Loam ❑ i .d '' r Hardpan ❑ Adobe.��' Fill Materia! -.,..._._.._ If yes,type ................ I I I � ` buildings, etc. must be placed on reverse side.) (Plot plan;, showing size of lot, location of,system�in�relation to' wells, # NEW INSTALLATION: (No septic tank.of seepage pit permitted ,if public sewers available ithin 200 feet,) , PACKAGE XREATMENT ( � SEPTIC TANK "j Size--- ----•. - _1 Liquid Depth: . ...*� _ ............. (� ci �cll . TypeY ...... 0arnpaments __.Capa � .......... . i r Pro Line s��- 1 Distance to nearest: Well .l�'_�...... ...........Foundation .�.- ----........--- p. �..__._...... LEACHING LINE QQ No. of Lines ------;�.............. Length of each fin ---- Go..•--•.••-•• Total Length .. .............•• t _ -- �- . ..r... �tp r k? of D Box ." -_- Type Filter Mdtenal !t"Cr--.._.Depth Filter Material ... .....-------•-•...:.........:... "' Distance to nearest: Well .._.rb_._r'_'_..... Foundation ..LQ..t......._.. Property Line .--••....•.•-•••.-- SEEPAGE PIT (�Q Depth ....' - ....-•_- -Diameter .:.�7 ____... Number ....... ' ---._.:.... Rock Filled Yes No �❑ t 4 t R �� Water Table Depth ...........r .:........Rock?Size ..-•----••-•- . Distance to nearest: Well .-. � �,--. 11h Line rlP'I.....•• Prop. Line .. REPAIR/ADDITION(Prev. Sanitation Permit# _•.---....... :"�- ti••---.....--• -Date .: .••-_....----• ii ) Septic Tank (Specify Requirements) ..........:.................... ----- •-•--•-•-.....--............ 7...... .. ...._..---------- ...............• -•-...... Disposal Field (Specify Requirements) ----------------------------------------------------- ...............•••---- ..t I� •--•--------------------•--•-•-•-........--- ......---..... ------------------------ ............1 -•-- .... -------_--- •---------. ........................ ............. -----------------.............I——..... ........................ IDraw existing and required addition on reverse side). 1 hereby Certify that i have prepared this application and-that-the work will be alone in accordance with San Joaquin County Ordinances, State taws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: °'1 certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed !'._.._.._.. -•----- ----•----- ---------•--- ••-----••- Owners 1,�jr B ...-•-• .... ......... By ....._.....�...... . .. - ---- •... Title ........_. _. ... f' (If other n owner) I FOR EPARTMENT USE ONLY I APPLICATION ACCEPTED BY = { ......f. ........... DATE .......-•--- BUILDING PERMIT ISSUED :.. .i. :1 -�*-��...:.............DATE ............ ......-----•--- --....--•.....' . --------••••---• �.. r.:.. . ADDITIONAL COMMENTS t '" `}' I�. _ ...._.'.-- _. t..('�).'i........................ ................•--•....... ....................................._.........---....----••....... .: •. .................... . .'!. ...... t -- --�'...._.. ...... ......:...................... ......Date Final Inspection by: _ _V , .SAN JOAQUIN IOCAL`HEALTH rl�I5TRICT r i c u 13 24 1_,Aa QA,. !;AA