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FOR OFFICE USE.-' . APPLICATION FOR SANITATION PERMIT _ (Complete in Triplicate) Permit 7 -........... ........................:................................ This Permit Expires 1 Year From Date Issued Date Issued .7.:�.3_-�.6 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/LOCATi ! .........CENSUS TRACT .......................... Owner's Name .yy........ ....... .. •---- ••-_ .------. Phone .............................................. _ ` Address ------------- ....... ' ?- .. ........ City •--- Contractor's Nama ..License .. ... YPhone ............................... Installation will serve: Residence❑Apartment House❑ Commercial❑Trailer Court C] Motel ❑Other --•• ... .............:... ` . \ Number of living units:....... Number of bedrooms4............Garbage Grinder Lot Size Water Supply: Public System and name .................... ....................................: • _................_...................................Private 47 UIN �. Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat[:]- Sandy Loam ❑ Clay_ Loam ❑ i Hardpan W Adobe Fill Material P ❑ If yes, type ...........................• z �, (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 see age pit permitted If public sewer is available within 200 feet,) ._ // 7- 'PACKAGE TREATMENT ( , SEPTIC TANK Sizegf�....X r1--_-_�f' Liquid Depth -64-1.................... Capacity ------- Type Material ------�.. No. Compartments .... - .... Prop. Line ........... .. ....... Distance to nearest: Well ......__._, bFoundation .....1.�. LEACHING LINE [/ No. of Lines ....../ .... Length of each line-------- ----- .._. Total Length ... . '0' Box Type Filter Material . -Depth Filter Material .....1 .`�................ -- ...... Distance to nearest:Well ........I-O.b.. .. Foundation ....... property Line ..... ... SEEPAGE PIT [ Depth -------a�-- Diameter __3�.�.. Number ....:... .. ....... .. ... —�----,.� l.. - . . Rock filled Yes �o i❑ Water Table Depth l ��. __Rack Size �'- --3. • - ...... Distance to nearest: Well ..........Foundation �_b.�` t... Prop. Line EZ ....... LA�=� .... -- - REPAIR/ADDITION(Prev. Sanitation Permit `'_._s::-........ -------- ..... Date ...................... Septic Tank (Specify.Reo P fY 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 .foaq-Vin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner of licen- sed agents signature certifies the following: "1 certify that in the performance of the work far which this permit is issued, 1 shall not employ any person in such manner as to become subject trnown6r)an's Compensation laws of California." Signed -.-..__._--•------------- ••-,-- . Owner By ----------••--------------•--.._ /!__..�i� "�� ' Title � ti.t_ (I :;;a# er FOR DEPARTMENT U% ONLY APPLICATION ACCEPTED SY ._._. ... ...........................•-•--•--.....................__....._._.... . 'DATE _:rl. _.�_......_..........._._.......-•-, BUILDING PERMIT ISSUED----------------------- DATE _-----L.._...............-----._... --- .................. .._,. ADDITIONAL COMMEN€S ..................................................•--- ---------------------------------- .......................................................------------- ................................................................................. ....... ...... ................................ ......I................ ....... ,._....... .......................................... Final inspection by: .....�u ..._....Date .rf _. . .�......................... ...... SAN J_ N_ .LOCAL HEALTH DISTRICT r_ 13 24�_•� _.