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FOR OFFICE USE: 1'1 APPLICATION FOR SANITATION PERMIT --�------- Permit No. -.-�3_ ` (Complete in Triplicate) -- This Permit Expires I 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 ----------- - --------------------------------CENSUS TRACT --------------------_--- Owner's Name .---�ayh- /..� �`��' "------------------------------------------- ---------------- -------Phone --------------------------...------- Address ----- / A+��AM, ;01.**---- -------------------------- -------- City i C .�� ----------------_---•------ rt Contractor's Name _ - � - 0� License # Phone i Installation will serve: Residence F] Apartment House-[] Commercial J$1Trailer Court l❑ Motel ❑Other Number of living units:-__ __---_ Number of bedrooms ________Garbage Grinder '00 Lot Size _61/24 --------------- Water Supply: Public System and name -------------------------------------------------------------- ------------------------------------------------Privateo Character of soil to a depth of 3 feet: Sand� Silt❑ Clay E] Peat El -Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type __________________________ i (Plot pian, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) it seepage ppermitted '+f public sewer is available within 200 feet,) OCA NEW INSTALLATION: {No septic tank or - � � � J PACKAGE TREATMENT [ SEPTIC TANK 14 Size_ _.ROOK-If _____________ __ _ Liquid Depth ,P-76------___...,____. � _ _ T e _-_ Material_C"11/_____ No. Compartments �-_______.�___-- �.. CapacitY�- --� -- Yp w � -.. /I < le Foundation �� p• r. Distance to nearest: Well ��iP------------------- __ Pro Line LEACHING LINE A No. of Lines ---,Y--------------- Length of each line?0__-_,9Z'-.lP Total Length ,.;O ------_------ 4 .� s, A � D' Box 0,5.- Type Filter Material/Z,/� -Depth Filter MaterialXe_ el----------------------------- For Distance to nearest: Well Z__0---- undation A ---��- --------- Property Line -��---------- 1�) f . ! SEEPAGE PIT [ J Depth --------- ---_ ----�-- Diameter ________________ Number __._ ----------------------- Rock Filled Yes [] No 0 '. WaterTable Depth -------.---------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation --------------------- Prop. Line ...................... REPAIRJADDITION(Prev. Sanitation Permit# --------------------------------------------- Date ____-___________________----------) Septic Tank (Specify Requirements)71.1_"�� - -------------------------------------:--------------------------------------------------------------------•---------- r , "r. Disposal Field (Specify Requirements)"'"�_ _ t ----------------------------- ----- ----=------------------------------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------- (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 Couniy Ordinance`s, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "1 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.” Signedf = --- -- ------------------------------------------- Owner 1 ---------------------------------------------- Title -------------------------- ?(Ii2th�erthan owner) TR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ - - - • ------------ ------------------------- DATE -----'2--��---7-------------- BUILDING PERMIT ISSUED`------------------------- ------------------------------------L--------------DATE - ----------•----------------------------- ADDITIONALCOMMENTSs'----------------------------------------------------------------- ---- -------------------------------------------------=--------•-•-------- ------- ------------------------------ -------------------------------------------------------------- ------------------------------------------------------------- ---------------- ------------ -- --------- -- ------- Final Inspection by: - Date - - SAN JOAQU LOCAL HEALTH DISTRICT- E. H. 9 1-'6-Rev. 5M J �.