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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. Z. .. This Permit Expires 1 Year front Date Issued Date Issued .. '7..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 isr made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .Jaz).0 -...--Ra—t 0.MC„__... , .�.................................... }� -` CENSUS TRACT .......................... Owner's Name ...... �1l ._.__. `1tesn��t�Ml"?C n...................................... .. ...}.�.].............Phone ................................ ._.. Address ... ..... f. .LQl�'YLC'.l.r. .��.'��...----•------- ... Glty A"lJ1 ... ,- Contractor's Nome - --XJ..i--_-- i t•JL�fi.� � '.�. ......._. t. ._......•••......License # , , .71.... Phone 2/6,di57`� Installation will serve: Residence-$Apartment House Commercial{]Troller Court ❑ Motel ❑Other ..------•-••-••;................•---......_ Number of living units:_._,__-__- Number of bedrooms -2------ Grinder ............ Lot Size ..... [..[� ...•.. Water Supply: Public System and name Private ❑ Character of soil to a depth of 3 feet: Sand o Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Cloy Loam❑ Hardpan 0 Adobe R Fill Material ............ If yes,type ............... ............ (Plot pian, 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 { 1 SEPTIC TANK I ] Size....--------•...........................•------- Liquid Depth .......................... 0 Capacity --------- •------ Type ....... •--•--•-•--- Material...................... No. Compartments ........................0 Distance to nearest: Well ....................................Foundation ...................... Prop. Line ......................0 LEACHING LINE [ ) No. of Lines ------------------------ Length of each line...................... Total Length ._......................... 'D' Box ------------ Type Filter Material ....................Depth Filter Material ....._.. ................................... Distance to nearest: Well ------------------------ Foundation --------- ............... Property Line ........................ SEEPAGE PIT { ] Depth -------------------- Diameter ................ Number .--------------------------- Rock Filled Yes ❑ No ❑7 Water Table Depth ................................................Rock Size ................................ c Distance to nearest: Well ...._._. ........Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------------------ - Date ......--•._.__._._.............._.) Septic Tank (Specify Requirements) ......ac�_,C-C.! .... 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.Dishict. Homo owner or licew sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is Issued, I $hail not employ any person In such manner as to became ub]ect to Workman's C mpesation laws of California." Owner Signed _ }_. '__ BY -- --- -- -------------------------------- ........... Title ............ (I other th wner) OR RTMENT USE ONLY APPLICATION ACCEPTED BY -- --- ---------- .._. DATE .r.J -.--_-- BUILDING PERMIT ISSUED ..__ . .... ¢ -P-------------•-_.__. ---------------DATE .... -•-•----- � / ADDITIONAL COMMENTS - ----- -- ------- ------------- ----- ----------- ------ - ------- ----••---- ------._...--- -----------......................................................................... ------------- ..... -•-------- ••------------------ f..... •----------•-- ....... Final Inspection by: ------- --- ---------- ) _ ....................... ...... Q �._........---- EH 13 2b1-6f3 lieu. 5M SAN 1JOAO IN. LOCAL HEALTH DISTRICT ( 8/711 3M