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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT . .......... •-•••-•---- ........... Permit Na. Icompleto In Triplicntel, .....__. .................. ................................... . . This PermltEx ices it Year from Dotelssteed Date issued..b. �' 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 ..` - ...............................CENSUS TRACT Owner's Name Phone ' .. ...................................................:.............. .....................------...._.__. Address of l-- .............:City .. ... O all-9. Contractor's Name ------ -- /l t'i�r ..:_-_:. License +' � .... Phone 1 �7: Installation will serve: Res#dance©Apartment Housefl Commercial QTraller Court 0 Motel Q Other..............................•---.:...._.. Number of living units ... Number of bedrooms ..Garbage Grinder Lot Size .................. ............ Water Supply: Public System and name w .......Private ❑ Character of soil to o depth of 3 feet: Sand Q. Silt o Clay Q Peas❑ Sandy Loam ❑ Clay Loam pp�� Hardpan❑ Q �1 Adobe Fill Materlal .:........:_ if yea,type............... ............ (Plot plan, showing size of lot, location`of system in relation tcr wells, buildings, ate. 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 l ] SEPTIC TANK f ] Size.................. Liquid Depth .................... Capacity ...... _-_ Type ... Material...................:.. No. Compartments ............. Distance.to nearest: Well __...___.•... .....................Foundation ..... ....... LEACHING LINE No, of Lines C �.:.:--------- Length of each line..._ . .............. Total Length ................ 'D' Box ...... Type filter Material ....................Depth Filter Materia! Distance to nearest: Well ........................ Foundation ............._..... .... Property Line ......................... f SEEPAGE FIT € Depth 3..X.(F.A ® Diameter Number ............................ .Rock Filled Yes Q No Q Water Table Depth ------------------------------------------------Rock Size Distance to nearest: Well ..........:...•• ....Foundation Prop. LIt1e ...................... REPAIR/ADDITION Prev. Sanitation Permit ---- Date Septic Tank (Specify Requirements) .................... Disposal Field (Specify Requirements) ........................................._........ ._ -------------------- -----------..-••--•-•••• i ---•---------••----------- ------------- ---- 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,01strict. 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 become subject to Workman's Compensation laws of California." Signed __... ...................... Owner k BY . .._...... .. •-•------•--............... Title ----------------------------.........._..-. (If her than owner) , FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _.. .- -- - ------ •-"•-----. DATE �s .'.1��_'.T...6................: BUILDING PERMIT ISSUED ------------ -------- ------ .........--------------DATE ADDITIONAL COMMENTS --------------------- •-•-••---...__--- •- • _ - -------------- .............. ................................. --------------------.-----------•-_...----•----_-_...................................._...._....----------•----------...._-- ---- _ -" ---- . ................... ina inspection by: .. ---- ------------Date ...�...2--.. ........ Ell 13 2!� 1-613 lieu. M SAN JOAQUIN LOCAL HEALT ISTRICT 8/?4 3M .__..._..