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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) PermItINa. . ...�... .. ..... ................. G!--.1........................ 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 Regulations: JOB ADDRESS/LOCATION ..(_.... ,.:.. .. .N._% ........:_...s.}....................CENSUS TRACT Owner's Name ............� ��..... ...�e!� !! tri ............................. .......... ..................#....Phone ..c $ tr i....... Address ........................ �Q!`!s?' - ................... .......--••-•-•.... City .... 7`�a etc„ �1............................. Contractor's Name ........... .:[T:... !` .f'.� tZ..'^::....License al= s`F ... Phone `6 Installation will serve: Residence fAportment House❑ Commercial❑Trailer C"oort 0 Motel ❑Other ...................................... Number of living units:,....(...... Number of-bedrooms_.. ._.,Garbage_Grinder ............ Lot Size ... .:X..trS?............. Water SuPPIY� Public System and name .............�. _ ..---�7rt ' '' - ..................................................-...:....Private ❑ Character of soil to a depth of 3 feet: Sand djilt❑ Clay ❑ Peat 0 Sandy Loam❑ Clay Loam ❑ Hardpan 0 ;Adobe 29 Fill Material ............ If yes,type ............................ (Plot plan, showing size of lot, location of system in reiatiori to Wells, buildings, eW must be placed on reverse side.) . NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is ovoilablei within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK f j Size................................,........--••-- Liquid Depth .......................... Capacity .................... TYp� .................... Material...................... No. Compartments ...................... 0 Distance to nearest: Well ...................y................Foundation ...................... Prop. line ...................... LEACHING LINE [ j No. of Lines ........................ Length oF.;each line... Total Length 'D' BQx ............ Type Filter Material ... .............Depth Filter Material ............................._......_...__.. VN Distance to nearest: Well .. .................... Foundation ........ Property Line ......................•. SEEPAGE PIT [ j Depth ........ ....... Diameter ................ Number ............, .. ......... Rock Filled Yes ❑ No i❑ 21 Water j Table Depth ..Rock Size • • : ' '� Distance to nearest: Wetil{.•-'•••-•--•-.•-•-•'•-•-•••-••,-•••---•,Foundation................................ ••••••••- •••••-•••Prop. line ' ....................................... REPAIR/ADDITION(Prev. Sanit4tion Permit# _ Date Septic Tank (Specify Requirements) .........................f .........................................,................................................. Disposal Field (Specify Requirements) .......: ............ 3.....x.......;�.... ......... .. ............••-------•-................I........................ ......... ..........•-- (Draw existing and required addition on reverse side) 1 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 become sub'eet to Wor an's Compensation laws of California." Signed ........... : By ........ .......... ...•-- ... +. l.Eli .............................. ,Title ti (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE ...... -..Q.,3- �,�... ................................................ BUILDING PERMIT ISSUED .............. ......................... ......DATE ADDITIONAL COMMENTS ........................................... ................................................_...............................................................:........................... .................................... -. ....................._........ :.............- ............ ...._............... ................. .. ... ...... ..................... ... ....... Final Inspection by: .......... .."'-" " '••..... - .... .. ......... ...... ............................Date ...::': ......... .....-� N JOAQUI LOCAL HEALTH DISTRICT E. H.13 241.'68 Rev. 5M 72.E M