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FOR OFFICE USE: r APPLICATION FOR SANITATION PERMIT ................ Permit No. r (Complete In Triplicate) - i This Permit 1 Yr,Frons Date Date'Issued - - 7� •-------- ................... Application is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work herein described. This ap'Plication is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRI:SSILOCAMON •. - CE .--Z .. � - ,. ........ ..I....------•........ CENSUS TRACT .......................... Owner's Name < fy .................. .:.. Pho-he-. -�f6�...._. . -• . Address .._......-•--- ---- .�f..S�1'`.-.•.•- } .. . .. ..... ........:City . Contractor's Name----------------- ------�.:---••-R-�-•---�r -- __ ......_..... ...... ,. ..........-----.�....-----------•----- , .-- -.License # 3 ........ Phone f _.�gAD ..._... {i Installation will e: Residence©Apartment mousefl Co m rclil OT aller Court 0 1 Y , Motel ❑Other € ter- �� Number f living units:- Number of bedrooms ............Garbage Grinder ........>.-_ Lot Size ...rr.Q...l`........................... a Water Supply: Public System and name ......._--...................___..- ..._ � : ............. _ .. .........----------- ................. �� Private ❑ � � Character of soil to a depth of 3 feet: Sand �� Silt Ga Peat., y p ❑ �Y [� ❑ 5an�dy loam ❑. Clay Loam ❑ 7 Hardpan❑ Adobe F1111M6terfal ._.._........if yes,type ............... ............ (Plat plan, showing size of lot, location of system In relation to wells, buildings,� etc, must be placed on reverse $ide.) , NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feet,( PACKAGE TREATMENT [ ] SEPTIC TANK I ] F Size................................I......... Liquid Depth ............. ' Capacity --•--- -- Type ............... Material.. •---- No. Compartments ....I................. Distance. to nearest: Well ._.Foundati n .._...--•------------------------ ...--------._........_ Prop. Line ...................... LEACHING LINE . No of tines ._.... Total Length ....._..... C l •-------------•--•-- -• Length of each line.-....... t ---• ...............-. 'D'I Box ............ Type Filter Material ..Depth .Filter Material tj Distance to nearest: Well ..........•_•......._... 'Foundation ..........I.............. Property Line ........................ �l SEEPAGE PIT { ) Depth -------------------- Diameter _-_---------- Number ...........1-J.............. Rock Filled Yes ❑ No OV Water Table Depth ---I........... .............Rock Size [ t� t �y ........a .•...........Distance to neareseIlL_ ....... . foundation ._.................. Prop. Line .....................7 REPAIR/ADDITION(Prov. Sanitation Permit# ........-.......#_._.•-_..._...¢- Date ......... .......................) Septic Tank (Specify Requirementsi ----- - ; ............................_. ..................... t Disposal Field (Specify Requirements) •-•--• -----•- �..- �C. -cc !�C� ......... ------ _...._.._ �- _ _ :.,r._.,...., �+ .� �� -�r1 ---------------------- ----------•........................ - � 33.._..x_ ------------ -- � - --------------- --------------------....----- --...... I i (Draw existing and required addition on,revgrse side) I hereby certify that 1 have prepared this application and that the waitk�will be 49ne in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin total Health,District. Home owner or licen- sed agents signature certifies the following: "I certify that In the performance of the work fowhich this permit Is Issued, I shall not employ any person In such manner � as to become subject to Workman's Compensation laws of California." . s Signed -- O nw er BY - ` 7-itieh..---- -- ___'.-- ------- --- {If o than owner) , t FO&DEPARTMENT USE ONLY APPLICATION ACCEPTED BY,---- ----------------- � --- ...................... ................. DATE BUILDING PERMIT ISSUED --••-------------------------=---- .. DAT . j.........------•• •. ADDITIONAL COMMENTS ______________ � _...._.. ------------------------------------- -: :::: ::: --- ------------------------ :::---- ----------------------------------:_................... .--••------ -----. ----•-------------- ........ ... -.-.._.._......--••--•----------------------------------------- _ }} � I Final inspection by: .._-.-_-- .........Date ---- �.f�U.u -.....---_--- EH 13 Zia rev• .... SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M t