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O OFFICE USE: APPLICATION FOR SANITATION PERMIT (— ....... ................................. ..---... Permit No. -�------------------- (Complete in Triplicate) Date Issued .................... This Permit Expires 1 Year•frorrm Date 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/LOC ION ,.1�q'S....-,.fe . ......-. ....... CENSUS TR.........................0 r_ J } - ,121ACT '� Owner's Name . . l f.L .......... ........J4.�I w �--. . wn . .......i?[tnne. ...............................---- Address . �,.)&qy..--- '"�- . 0d. -•--• ------ ••-- -•-=--...:..'City _.p�� c -Cat.sr.....:..:..... . .......... .... _ /, 17t .. t. :-_:_...Cicense # :30.57.�'l..:._ Phone' Contractor's Name .[.�._._-....... �•�• - - Installation will serve: Residence 2�Apartment House❑ Commercial ❑Tra€ler Court ` Number of livingunits:.____-__-_ Numberofbedrooms ..... __-...Garbage-Grinder ............ Lot Size ...............--------...................... Water Supply: Public System and name .............. -••-=- - --..:...------------...._......--•----....--••-- ...................Private Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay❑"7 Peat❑.) .. Sandy Loam lay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ...... _;_.. If yes.type .............................. r (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 Size... _.... Liquid Depth .6.0................ 111 1 Capacity Type -PA&V —Material.&A344No. Compartments ...a.......... _.. ' 'T. •� i � Distance to nearest: Well ____....�.C9 .�................Foundation ._�cT._........__.. Prop. Line ... j f LEACHING LINE [ ] No. of Lines _..•;�-------------- Length of etch .line.......e ............ Total Len th rr ........ D Box ----- Type Type Filter Material J--__.._-:•--•--•--Depth-.F€Iter-Material L,:2-._......._--- ...... —Distance to nearest: Well ._. .- !1_•--.:...:;Foundation _30_1............ Property Line ----••--- ( X vE ......... Rock Felled Yes M_-"No 0SEEPAGE PIT [ Depth Number ..... ..... Water Table Dept, .. .. ° ` Rock Size-1-1. ; . 11 Distance to nearest: Well ..: ?.:::-•.---- ...........Foundation ./.-I-47--..._... Prop.'Line ----............... .__ REPAIR/ADDITION(Prov. Sanitation Permit .................•.......................... Date -------------------•--•-.---------•) ' Septic Tank (Specify Requirements) ..:.......... ......................... ........................ .................... ..............................._.......... ......_ k Disposal Field (Specify Requirements) ..................................... --•_---------------- ........................... . k .............. .._._.. :�' ---- - r- = .............•_.... .------•--....-----•--•....:................... ..................................................... ---------••- -----------------........----•------ (Draw existing and required addition on reverse side) 1 hereby_ertify'thot I have prepared this application and that the work will be done in accordance with .San Joaquin 4; County Ordinbnces, 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 €s,issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws .of California.", Signed ...........:..:.......................................:...: Owner .... ��.(�.. ---:-- Title ---------------- 8Y ____ (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ..............4& .-. ...................... .:............................................... DATE ...... ........... ...... BUILDING PERMIT ISSUED ..._..--•............................ .........I....---- -. ...-_....._....._ . -_...........:.__.......DATE....... --.�. - ...__. - _ ADDITIONAL COMMENTS . � - � -••• r 1 :.................... ....:.................•-•• --........ " -------_-------•---::.. 'f------------ •-------------- --...- --- .--•-•- � � ............ " .... Date--• .......... _. SAN JOAQUIN "LOCAL HEALTH DISTRICT r; Rr 13 24 7172 3 L