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FOR OFFICE USE. *' APPLICATION FOR SANITATION PERMIT ......................... ...... ............--•- 0 3 Permit No.7`= ........ I iComplete in Triplicate) 1A This Permit Expires I 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: rl __ JJ sG�1 .. JOB ADDRESS/LOCATION. ... -• ' .. -TRACT Owner's Name ................. .......�_ .. - i7 ._ . .....-•--••..................••............... •-- .--........Phone Address .................... 1 .� ....City ------ - Contractor's Name = �d�d"'�----- �[ ... �� - z �+� ioense il `, 1._ Phone . ._. Installation will serve: Residence Apartment House❑ Commercial OTraller Court E r Motel 0 Other------- ........................... �j W.-t. Number of living units:.._, Number of bedrooms .....Garbage Grinder __ .. ._. Lot Size .. 2 ...................... Water Supply: Public System and name ....................................... ....Privat� Character of soil to a depth of 3 feet: Sand� Silt❑ Clay p Peat❑ Sandy Loam ❑ Clay Loam❑., Hardpan Adobe Fill Mcterial ...__.__.... If yes,type (Plot plan, showing size of lot, location of system in fetation 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 204 feet,) PACKAGE TREATMENT [ ].: SEPTIC TANK f ] Size................................................ Liquid Depth .............. .... ......�. Capacity ---- ---------- Type __--• ------ . Material.. •.-. -------- --- No. Compartments ...................... Distance to nearest: Well ....................................Founda#ion .--_............_..... Prop. Line _ 'I,, .......... LEACHING LINE e ] No:� of tines ................:..�:... length of each fine_.......................... Tota! length ---..------•--......--- ...... twi toj* 'D':Box .._...----_ Type Filter Materialµ:ms::..............Depth filter Material ...........-................,.............. . l Foundation_; Distance to nearest: Well.--=--=------------------ 'on .----...-------•.-...... Property line .................. �� ..... [ l Depth _. ----...---------.._. Diameter _...---•---...- Number..--'......................... Rock Filled Yes No 0Y e let S. /-aS Water Table Depth ----------- • "; ••-•---=----- -=------ .............Rock Size ........................ Distance to nearest:`Well . ..........................Foundation .................... Prop. Line REPA1Rt ADDITION Prev. Sanitation Permit# .............................................Date ............................... _.} Septic.Tank ISpecifV Requirements ._�� .. ./��` ,�• � .....��„�,,�'�� .,._:.. Disposal Field (Specify Requirements) ` ---------------- ------------------------- . ......... •• -. ................................... .---•--------------------- ----------------------• _. -••------•------------------------- --..._. ........_.-_.........--•- ..._.................-•-•----•••••--------------------------•--• II (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;Dlstritt. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person In such`manner as to become subject to Workman's.Compensation laws of California." Signe -•-- Owner BY ---. . . - ._. title - _ 6 .. V (if other th n own IF DEP RTMENT USE ONLY APPLICATION ACCEPTED BY e. ---------------------_-- ..--_- ...---• .. DATE . ` ..� ... BUILDING PERMIT ISSUED.. . . . ...DATE ADDITIONAL COMMENTS ..- .-_.7 ..-.._-- - �•G1 3 - 3 �� - ....--... ---------- Final Inspection by-. . i pt �6 ------------............ Date ... .' ' EH 13 21a 1--6 Rev. 5MSAN JOAQUIN LOCAL HEALTH DISTRICT 8/7 3M