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FOR OFFICE USE: - APPLICATION FOR SANITATION PERMIT ................. ....... .... � �� (Complete In Triplicate) Permit No. ... . ..."••" ................................................ -----•---•-----•-•....................................... This Permit Expires 1 Year From Date Issued .: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 R �e lg �ulations: � JOB ADDRESS/LOCATION ...„ s _.. �,.../ .f !!tflV f :.�. . _ ....................CENSUS TRACT Ae,.q:�'*�,,�a Owner's Name :- ..............................................._....n...............,......Phone ......... ... ...................• Address 33 o6. -�(G^. - .e Q^�..... .' ........ .. ... . •--....... City .. .A,, jq 1 4pct,, ...... ,........ ........ Contractor's Name _.64C....� 7rt.6.-__.rgih lZ.. ............ ..License Ilk 377 ....... Phone Installation will serve: Residence[kApartment House❑ Commercial❑Traller Court 0 MotelQ Other............................................ Number of living units:.----------- Number of bedrooms _3....Garbage Grinder ............ Lot Size ............................................ Water Supply: Public System and name ..:-•------•----•-•................_............-•---........................................................Private a Character of soil to a depth of 3 feet: Sand b Silt❑ Clay ❑ Peat❑ Sandy Loam je" Clay Loam ❑ Hardpan❑ Adobe❑ Fill Material ............ If yes,type............... ............ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.)O NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 240 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK{ ] Size..... .................................... Liquid Depth .......................... Capacity ------ ------------- Type..................... Material...................... No. Compartments ...................... Distance to nearest: Well'-�..................................Foundation ...................... Prop. Line ...................... LEACHING LINE [ j No. of Lines ........................ length of each line --------------.-..... Total Length ............................ 'D' Box ._.... ....- Type Filter Material ....................Depth Filter Material ............................................ Distance to nearest; Well ........................ Foundation ........................ Property Line ........................ SEEPAGE PIT [ ) Depth ..... .............. Diameter ................ Number ............................ Rock Filled Yes 0 No i❑ Water Table Depth ....... ---••..............• ...................Rock Size ................................ Distance to nearest: Well ........................................Foundation --..--.............. Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit ilk _.......... ............................•---,Date ..................................} SepticTank (Specify Requirements) .......... ...........................................................................--•--...........................--••-.................. Disposal Field (Specify Requirements) .-----5 5 ......... .�LN4..---- ...._.__..:......... .. .. . . -- .. . ....... . - . ................` a..Lp7. ------•-----. - ---------------------------- - --------------------- --------------..............._................. -----------•---....---.........-----------•--•----•-•----......_........... (Draw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work wiN 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 Ilcen- sed agents signature certifies the following: "1 certify that in the performance of the work far which this permit is issued, I shalt not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed •------------ Owner By --.._. Title __. UI► ^- - -------C ..��Y � (If other than owner) _ �n FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -----C> -- - - ------- � ----- DATE �� ------ BUILDING PERMIT ISSUED •--------10- -----................. ... .......... DATE __.._ . ........... --------- ADDITIONAL COMMENTS --- --_------------------------ ........ ---•------•-•---- ....•---..........--------------------............. -------- ----- ...............-..-----........................... ........... ----------•------------------- ................... ------- ........ .-- - - ..... FinalInspection by: . -• ------•-----•---------•-.-_.-_---•------.,._..------- --—................Date -- ---- _ ... ...__!.....:_... EH 13 24 1--613 1(ev. 5�1 SAN JOAQUIN LOCAL HEALTH DISTRICT 8�7h 3M