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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT G� -(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 com liance County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCAT N .-- �_//�----- ---- --------------- ( - co CENSUS TRACT Owner's Name --- ---�--�-- ------ ------- �� Phone 441 --�-- ----- �....._ - 17 Address'--------- _ __ City ----- -----------�'1_ - ---- Contractor's Name --- -------�-S-------------------------------------------------License 9 ------ Phone� �_1,�-Z-7k� Installation will serve: Residence Ry-Apartment House❑ Commercial❑Trailer Court ❑ Motel ❑Other ------------- ---------------------------- Number of living unitsa".._/....... Number 6f bedrooms°-3____-__Garbage Grinder ------------ Lot Size" _ _x_l-_ _ _______________ Water Supply: Public System and name _.------------ ----- ---------------------------------A------------------------------------------------Private F-1Character of soil to a depth of 3 feet: Sand'❑ Silt Gay, E] Peat❑ Sandy Loam ❑ Clay Loam,El Hardpan Adobe ill 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.) NEW INSTALLATION: (No septic tank or slepage pit permitted if public sewer is available within 200 feet,) 4 t 1 PACKAGE TREATMENT { SEPTIC TANkf Size___ ->{__z(__I-aC-_ f.--_-_____ Liquid Depth _/_ --- -------------------- Capacity _1�z,ab _._- Type / � s, Material_____�-,�_0.dNo. Compartments _ V - Distance to nearest Well _-`_—_________________________Foundation fa_f___________ Prop. Line _ �__J--___-_-___ Ie LEACHING LINE V,�- No. of Lines ---. _ __ Length of each ----- ------ Total Length _liS _______________ 'D' Bo ____-_ Typa Filter Material - -=�C-�-------Depth Filter Material --18--------------•---------------------•- Distance to nearest: Well ___-"__.___________ Foundation gip__________________ Property Line �_�--------------- le SEEPAGE PIT `[� Depth _�^_________ Diameter _3-_�_-___ Number -----�_________---_--- Rock Filled Yes f�}-' No C I Water Table Depth __________________Rock Size -------------------------------- i ---- Distance to neareAt: Well _______________________________________Foundation -------------------- Prop. Line ------------_-------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date _________________________________) Septic Tank (Specify Requirements) ---------------------------------------------------------------------------------------------------- - Disposal Field (Specify Requirements) ------------------------------------------------- ----------- ---------------------------------------------- - - ------------------------------ ------------------------- - ------ ---------------------------------------------------- ------------------------ ----------- (Draw existing and required addition on reverse side) I hereby certify that 1 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, 1 shall not employ any person in such manner as to becom u Iect o Workman's Compensation laws of California." Signed _ _ "O 3- -S ---- ------------------------------------- -------------------- Ovvrter-_1 By --------0C ` Title ---t?