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ti FO�JOFFECE USE: !I Ik APPLICATION FOR SANITATION PERMIT //��`''/ .............. ....----...... .- Permit No. .7Z1-.. -- (Complete in Triplicate) I : 1 . .. ...... ... ..................... --. This Permit Expires ] 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: lJOB ADDRESS/LOCATION r-•................XA:: ......CENSUS TRACT .......................... Owner's Nome .............. ........................ .......Phos - c ."rj ... . Address ...�` ------.1� U.r. ..�4� •'G L`---.. -1%. C --------- City ......��jv.. ..5':TG...•............. a Contractor's Name ...... .......... ... ..License # ............__........ Phone .---._.....;.................. Installation will serve: Residence XApartment House❑ Commercial []Trailer Court Motel ❑Other ..... ......................... ----_------ Number of living units:......t.. . Number of bedrooms _.------Garbage Grinder .... Lot Size .... ................... Water Supply: Public System and name ..Private ❑ Character of soil to a depth of 3 feet: Sand T-1Silt C-) Cloy C] Peat E) Sandy Loam Clay Loom ❑ 'h Hardpan ❑ 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.) E Q NEW INSTALLATION: (Nod septic tank or seepage pit permitted if public sewer is availablewithin204 feet,) PACKAGE TREATMENT ( ] :' SEPTICTANK-f ] Size... Liquid Depth .......................... CapacityFt i)fj.% 11Tp , ,,.crP �: No. Compartments .....L2..•... Distance to nearest: Well . .....� _.�..-..__._..........Foundation Prop. Line ..�U.. .�_.. LEACHING LINE No'' of Lines cZLength of each fine- ../U U ..... .._--. -Total Length ..a-`��.�............... 'D• Ii,Box ..•,. -.._ Type Filter Material ....................Depth Filter Material ...............__.................. ... ..Q Distance to nearest: Well Foundation Ad--- Property Line _. ._............_.... SEEPAGE PIT De the . . Diameter . Number .._ Rock Filled, Yes No p -. . 4 ....... .�. ❑ Water Table Depth ............-•-•- ---- ---------------------Rock Size ----------------- ,. Distance to nearest: Well ......... /aq ......_Foundation ------.._..-.....•. Prop. Line _....___._::.. rn i REPAIR/ADDITION{Prev. Sanitation Permit# -------- Date ----------------------------- Septic -----------------------Se tic Tank (Specify Re uirements) ...... ................------------- •:-- F Disposal Field (Specify Pequirements) ------------------------------------------ -•--- ---------_-- ..................................... -- -----•----.y.......:._ ............................•................ ! .. -------------- --------- - -- -..------- ------ ----- -- .... . --- -----------------. ••---• r �y - -. - Daw 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. owner or licen- sed agents signature certifies the following: "I certify thatin the performance of the work for which this permit is issued, I shall not employ any person in such mannan. as to becomu:bl.ect to W rkman's Compesaaws of California.Signed .: ... - ---- - ---------------- Owner 3 t Title ...... (If other than owner) 4 FOR DEPARTMENT USE ONLY _ APPLICATION ACCEPTED BY ...-....`..r�—...... .... DATE .......7` o. .7..L-----.- B,.ILDING PERMIT ES5UED .!:....:- . DATE ................_...........-...--•--•.... ADDITIONAL COMMENTS ..E.-..-- ................................................. --................. ............ ................... ..... . -•------------- ---- ------------------ --- .......................-........................................_........................ ..... ' ........................................... . .... . ------- -- :. ---•------------------•------.--•--....---.. ... �.. -....... Final inspection by: Date .,..j -X3`-..7�. IL .-.... -- ----- ----- :s SAN JOAQUIN LOCAL -ALTH DISTRICT ��7 ti'' 'r1 4 •�� x �- x 3 .