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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT G j (Complete In Triplicate) Permit No. ..��`-��1 .................................... This Permit Expires 1 Year From Date Issued ©ate 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: JOB ADDRESS/LOCATION ._.l-.- _r`� �C CENSUS TRACT _._ ..._ .................•--..._...._...._............... Owner's Namer� ._ ... .....Phone- I City Address L. ...� ...... `Contractor's Name ----------------------- - ---•_. . .............License # .21:_. 2...• Phone ��.. Installation will serve: Residence[ 1 artment.House❑ Commercial❑Trailer Court 0 Motel ❑Other----•------------ ---------- -----------•-- , Number of living units•_._1 Number of bedrooms _2e?...Garbaa Grinder Lot Size Z v Water Supply: Public System and name .......................L,:.011101 ....6..4.1 C...............................................Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Ga ❑ Peat❑ Sandy Loam ❑ Clay loam ❑ Hardpan Q 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 tonic or seepage pit .permitted If public sewer is available within 208 feet,) y PACKAGE TREATMENT [ I SEPTIC TANK�� Size ---------- Liquid DepthJ' ....'T.......---•------- Capacity,lct,0Re0..___ Type Material-42,----------- ...... No. Compartments ..-- 4t........... , Distance to nearest: Well __................Foundation .1._..___.......... Prop. LineIf(-] LINE [� No. of Lines _......s� ALEACHING _ ____________ length of each line._v`�..._...��-. -_ Total Length ..�U�... .'D' Sox .._� - Type Filter Material . '?!_Rklep Filter Material ......_._,� ...............Distance to nearest: Well .. _ Foundation -�Gt�........_... Property line ...c?......SEEPAGi= PIT [+.]� Depth ---��_ Diameter _� ._.-- Number .---.....�----_-- -_-- Rock Filled Yes � Water Table Depth -----... �:..--•---------................Rock Size -ped ................ Distance to nearest: Well -----•---- ••------Foundation ---- Prop. Line . REPAIR/ADDITION(Prev. Sanitation Permit# --------------------------------------- Date ---:•-----.__.__......__----_-.--} ' Septic Tank (Specify.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 Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health,District. Hoare owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person In such manner as to beco bl t to W anis Compensation laws of California." j 7? Signed ---- - -- --------------- ] ----------------- --------- Owner i By --- --- Title --..-- (if other than owner FOR DEPARTMENT USE ONLY APPLICATION 'ACCEPTED BY ....... --= CX_ ---_.. DATE`S` -? BUILDINGPERMIT ISSUED ------------------- ----------------------------_ ---------I........................................ ---DATE ------------------------------------------- ADDITIONAL COMMENTS .. - ------- ------=--------------------------------- ---•---••-•- ........... . ----- - ----- -----------------------••--_------------------- --•-----------;:: • ---------------.... ---------------- ; --------------- ----------1 Final Inspection b /!s._.... -•- - `� .Date _..._ 13 2 ""& mow• 5mSAN ..l AQUIN LOCAL HEALTH DISTRICT 3H