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FOR.OFFiCE USE[ AN APPLICATION FOR SANITATION PERMIT ......... Permit No. �� r ............................. ICemplete In Triplicate) -................. .. ........................ Date laaued S` J ......................................................... This Permit Expires 1 Year From 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 JOB ADDRESSA iON . Lf . .. . ......CENSUS TRACT ........................... Owner's Name _ ............... ............ ......•...._ . . .............Phone .............................. Address -- ._... .._.... ............................... Contractor's Name _._.._ :-�... Tw ��^^'�°.._........._•___••_-_...: License # .f�4_ -.... Phone .............................. Installation will serve: Residencb Apartment Houses❑ Commercial❑Trailer Court 0 Motel []'Other_-•-------=-----------..................... s Number of living units..... Number of bedrooms 3 Garbage Grinder ............ Lot Size ............ Water Supply: Public System and name ---------------------_---_--................. _....--------_...................•-- ...............Private Character of soil to a depth of 3 feet: Sand❑ Silt❑. Clay ❑ Peat❑ Sandy Loam tJ _ day Loom ❑ Hardpan[P' Adobe❑ Fill Material ............If yes,type ........ .. ............ , (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed an reverse side.) NEW INSTAMATIONt (No septic tank or seepage pit permitted if public sewer is available within 200.feet,) PACKAGE TREATMENT [ J SEPTIC TANK( J _ Size.:--�:........................•-___•_-___.._..._ Liquid Depth ...........................�[ Capacity: ......:........... Type-....................Material...................... No. Compartments -•-------_---------.,J Distance to nearest: Well. ....................................Foundation ...................... Prop. Line ................ LEACHING LINE [ J No. of Lines ---_------- --------- Length of each line............................. Total Length ............................. r D' Box Type Filter Material Depth Filter Material-.........1Z...................... 10 Distance to nearesh Well ........................ Foundation ..........:............. Property Line ........................� SEEPAGE PIT, [ D Depth .................... Diameter __.._..-.-:___-: Number ............................ Rack Filled Yes ❑ No Q9ty Water Table Depth ------------------•-••-------------- ...........Rock Size ............ ................... a � 'f ..............._.Foundation Prop. Eine - Distance to nearestc Well •---•--•---•---:•-•--•- ................. ...............:...... REPAIR/ADDITION(Nev- Sanitation Permit -------------------- Date .............-_............... ....) Septic Tank ISpecify Requirements) ....................................... . --.... . .:........... ....... ....... ......... ---••-•---••--•-._--..... .........._...--- ...... r Disposal Field (Specify Requirements) p 5 .......:............ ....... ..... - ..... -�!--1�....._....�..._ �.. . .� •-- ---- 3. .......... ..._.__. ....................................................................................................................................................................:.................................... . (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 Sats Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Hoene owner or Ilcen- 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." Signed ---------••-----•--..._ .............. . Owner 131 xitle v'�' ^ _..._.......... (if other than owner) FOR DEPARirmgNT USE ONLY APPLICATION ACCEPTED BY ... ...::............:.....:....:.......:................................................,..DATE . BUILDING PERMIT ISSUED .DATE.....:.....::.. .................. ADDITIONALCOMMENTS ._..-...-__....-.-............_...................•-•-..........-----..........---..--....._...__............. -P---.._.__................_...---.._..--•- .......... ....... ..._......._--......-_.. I. . ....©ate .. ....._.... Final inspection by ,.. . �, _....._._.. EH 13 2 3-Gi3 Nt3'v. 1 SAN IOAQUIN LOCAL HEALTH DISTRICT 8�7h 3M