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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. --------------- This Permit Expires 1 Year From Date Issued Hate Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein 4e4GWbed—Thia-applicationAsa.made,ina cor.ppliance with County Ordinance No. 549 and existing Rules and Regulations: _ lid-J15-111-5's DR5SSAOCATiON ------- - -lftn---- (/sa s = . I CENSUS TRACT Owrer's Name - EC► L --------------------------------- f?-T-F---__--------------------0-0 �-.:-----Phone Addres --_�'A�r Ft-cv�L{}Ej�(�_L: �illAT� L-�� Cir % l r.l- --- Y !'--�3fCi ----------------------------- --- Contractor's Name - Tf F------ ------ --- ---------License # ----/&!/_dj Phone _-Cl- -��- Installation will serve: Residence Apartment House❑ Commercial'❑Trailer Court ❑ Motel D Other Number of living units:--- ------- Number of bedrooms ---Z.---Garbage Grinder ------------ Lot Size -_ p----X_-_-1,�� ter- - ------ Water Supply: Public System and name .kn__7?j�P------__ f 1Z:,---- - -f-------------------„--------Private ❑ Character of soii to a depth of 3 feet: Sand�f Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam E]Hardpan E] Adobe ❑ Fill Material ,f_,_vf_�_-- 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 seepa it permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ j SEPTIC TANK Size__3_X--10_-_X-_�Y � Liquid Depth _- ---------- 00 Capacity -- 0- - --- Type - Materialtbl�•� -qVo. Compartments -_ istance to nearest: Well __ a--------- ------ -----Foundation =�__l_ ---------- Prop. Line --_-�--.__-�_-_-- c�, LEACHING LINE No. of Lines ------/_-_-------_- g �d-O ____---_ Total Length --_- d O -- Length of each line--._-__ _- f 'D' Box -- - � Type Filter Mateir�ial/- - -Q�-t�_--Depth Fllterr Material -----_�- .--_._--_---_---f_.-.----_ _Distance.to nearest: Well -. u`�--- __--- Foundation __10 _ _--.- __----- Property Line - - - --- .� SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number -------------.-------------- Rock Filled Yes ❑ No i❑ Water Table Depth ------------------------------------------------Rock Size ------ ------------------------- 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 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 that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to becornbjec to War an's Compenosatii laws of California.” Signed [!Y` e - `- ------------------------- Owner T� BY ------------- ------- - ---- - - --- - ---------------------------------------------------------------- Title (if other than owner) FOR DEPARTMENT USE ONLY ! APPLICATION ACCEPTED BYTl_R` - --------------------------------------------------- ----------------. DATE -- BUILDING PERMIT ISSUED ------------------DATE -- ADDITIONAL COMMENTS --- - -----------------------a -------------------- - � ---- - -- - ------------ ------------------------M --------------------------------------------------- -------------------------------- ---------------------------------- ------ - -------------------- -- --- ----------------- -------------------------------------------------------------------------------------------- - - - ---------- Fi ��{1 - ------------ ----------------Dote --- -- - 2 SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M