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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 ..a=/J. 7.. 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 .. _...�`��d .. I/tJs, 'p CENSUS TRACT .......................... Owner's Name .` ........ ...-_._. � (�,................ ................................ ................. ----Phone ..................... Address ......f ( 3----- ............ Cit Contractor's Name ...c ......... • -------......................-----.License # ._..-_------- --- Phone ............................ Installation will serve: Residence ❑ Apartment House-C] Commercial []Trailer Court Motel Other ..6?eei...7 Number of living units .... Number of bedrooms ......Garbage Grinder ............ Lot Size Water uPPIY Public System and name - •---- •------- ------------- --- ..........Private Character of soil to a depth of 3.feet:.- .Sand__ {Silt . ;Clay- . ._-..Peat: Sand. „Loam,_ .^,,,Clay -Loam_Q Hardpan E) 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.) NEW INSTALLATION: (No septic tank or seepage pit-permitted if public sewer is available within 200 feet,) . " PACKAGE TREATMENT [ ] SEPTIC TANK Size . tom_ ---- Liquid Depth .................... S Capacity / - Type?% ' ._.r;.� Materia(-.�-�►� e- No, Compartments ___�.........� a Distance to nearest: Well J11 �Jfa_.�......... .....Foundation .:... ----•--_--...... Prop. Line ............. LEACHING_ LINE [ Na. of Lines : Length of each line ��... ... .. ...... Total Length -.1049........ . D' Box� .:- Type Filter Material.- Depth Filter Material ................ Distance to nearest: Well _ ---:-• Foundation :..................... Property Line V .. ................... SEEPAGE PIT [� Depth .!Z --•--. -_ Diameter y�X1©' •�• Number ...............►........... Rock Filled Yes ❑ No 10 Water Table Depth - ------ ......,--.Rock Size ..................... ---•- S Distance to nearest: Well -------------------------------,=--_:_.-_Foundation _......... . ..-_... Prop. Line ......._...........-. - _ a REPAIR/ADDITION(Prev. Sanitation Permit# .-----------.---_..._ -----• ----: Date -- ------------------------------) Septic Tank (Specify Requirements) .._.._ . -•.- . • I -,R„- r •-•--•. • ............................................................ i Disposal Field (Specify Requirements) .............._ -------------- ----------- ............ -............................... ............ :. ............. . . ...... ........ .. -. --------- ---------- -- ---- .................... • (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 County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home ewnel �or licen• f sed agents signature certifies the foltowin 1.' '" "I certify that in the performance of the work for which this permit is -issued, I shall not empioy any person in such manner as to become subject torkman's Coinpensation-10- v4-of _ Signed .:. ' "........ ..... Owner By - _ . . ........ ................. .............. _.._.. Title . ....... . (if other than owner) ��- _—__. :�— __8y . _—_— - E ONLY f • J r . APPLICATION ACCEPTED BY :_. -,.. ............ . --•.... ................. DATE . .. �� BUILDING PERMIT ISSUED :. - .................. ATE ADDITIONAL COMMENTS ......... ............. ..----_----------------------- ---------------------------- ---- •---.... - Final Inspection by: .. /4- --------------------- -------- _._..., . ...........Date ...tf`�..�`. ._ ..... :._. SAN JOAQUIN .LOCAL HEALTH DISTRICT .E. N i3 _24 L '6B.Rerr_5M ~i