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FOR OFFICE USE., APPLICATION FOR SANITATION PERMIT �] Ice Permit No. ...7�mplete in.rriplicawf ..................... ..11...�. ..•.....---- e o� .. .� . _ .._...-., _ . .. _ T Permit Expires 1 Year from bate 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 comp ' nce with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESSAOCATIONA- ' CENSUS TRACT Owner's Name ............ .................................. .....Phone .. .. Address [� . .._.�'.�-.....-..-•---. .... .--- .... /� /��7� ..............:............. City 5,a �d •-•............. . Contractor's Name .�-.,��_ (�.__�.r�:2 �.� }� .................• -•--• ......_ •...._.license # ... Phone -� Q Installation will serve: Residence Apartment House 0 Commercial o'fraller Court � Motel Q Other .. ........:..•-----------•- Number of living units:... ------- Number of bedrooms � d __...G age Grinder, �� .....�..... size ...-----....�.. Water Supply: PP y� Public System and name .-_ ` /�� -^..........Private ❑ Character of soil to a depth of 3 feet: Sand'[] Silto Cla i Y ❑ P t Q Sandy loam ❑ Ciay Loam :Hardpan 0 Adobe 0 Fill Materlal .......,....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 seepagepit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT I ] SEPTIC TANK Size. -... � •.............. liquid Depth ........................... +}. �. _ °f YPe -_. Material._._ Capacity _>- - No. Compartments Distance. to nearest: Wellr g - -Len th •--'------••---Foundation -•• ..Q.-_-....._ Prop. line _..� LEACHING LINE ( .. No. of lines ...Z._ of each I' ------••-•--• e.._... Q.._ Total Length — 'D' Box ............ Type filter Material ---- ---_ �j -------- ©epth .Filter Material .....I.�.._....•................... Distance to nearest: Well ._A�'?1-�,_...... Fo n ation .......... Property Line .... __ SEEPAGE PIT j< Depth -__-�,;_ --••-- Diameter �r ~- ----�-- �.T urrnber ------- .................. Rock Filled Yes No ❑� Water Table Depth 1-.: ------------...... ----•-----....................Rock Size Distance to nearest: Well ..---•--.--_-___• Foundation Prop. line " ....---- 47 REPAIR/ADDITION..Prev..Sanitation Permit " � ... ....... ... ( ------ Date Septic Tarik%(Specify Requirements}. ..__.. •------•--•.•--- • ------------- _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 County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Heaith:Dlsfdct. Home own sed agents signature certifies the following: or or licen- "I certify that in the performance of the work forw_ as to became suhich this permit is Issued,1I shall not employ any person in such manner b) to Work an's Co ensation lawsof California," Signed . BY ------------- -------- (if •---- - � _..-.- e .. .... . .......... title ..... �,•/ ----+ .................. {If other than owner) - - FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY,_.- - BUILDING PERMIT ISSUED -------------- •-------- •--------•- ............. DATE.:.�__"u'Z'�.'_./n'�------ ADDITIONAL COMMENTS ---------- •---------------- --------------- .._..---- --- --------------DATE .......................................... ------------------------- Final inspection by: .-- EH1313 2 r ------------------------------------------ ._. JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M {