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11. FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. // ------------------------- (Complete in Triplicate) / Date Issued -, This Permit Expires 1 Year From Date Issued 411- 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: .. _ --- Owner's - ----------- JOBCENSUS TRACT ADDRESS/LOCATION --- -� ��=--=- =----- ''��- ---- -=---1----- ----------- - Owner's Name --t J;I �*----�a_�h-t------�r��P---------.---------------- -•-------------------Phone S Address 4- `�' 11e-IAIR---•------------------------------------------------- City _�.f�e' - ��9 C��5Cd_ F ll ' Contractor's Name -_� t' 1_ °- _____5 -e_j------r/-vC=-------.License # ---- Phone Installation will serve: Residence ❑Apartment House❑ Commercial ❑Trailer Court ;0 Motel,'Other Number of living units------------- Number of bedrooms ------------Garbage Grinder ------------ Lot Size -------------------------------------------- Water Supply: Public System and name ----------------- ---------------------------------------------------------Privateer •�, I Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peau Sandy Loam ❑ Clay Loam ❑ C Hardpan F-1Adobe'o Fill Material ------------ if Yes, type ---------------------------- C (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 seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK Size_ �-V-G � �f------------= Liquid Depth _-s-_---------.-.--- � Qi-gw �wa�o0D T spA< Capacity/b --C)_,-- Type Material No. Compartments -__rr .-.-.- ----- -_----- Pro Line Distance to nearest: Well n ------------------------Foundation _/10---- p. �N LEACHING LINE No. of Lines ------------------------ Length of each line -_-_X(_1`'-----.- --- Total Length t /'D' Box ------------ Type Filter Material -s'-/,%C-*epth Filter Material �_--.--_---------------•-•----- i Distance to nearest: Well ��-I--t----- Foundation �-D--_----- Property Line --_- _� --- SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No Q Water Table Depth ------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ----------__------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ------------------------------- Septic -----------------------------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 be a subject to ork n's Compensat" laws o€ California." Signed Owner 4�J ------------------ -Title ------------------------------------------------------------------------ ' (If othe t ari owner) OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -----f _.. - ------------------ DATE ----.- --------------- BUILDING PERMIT ISSUED -------- -------------- -- DATE ---------------- ------------- COMMENTS ---------------------------------•-------------------- ------- ---------------------- -------------------------------------------- f------- ------•----------- ADDITIO - --------- ---------------- _________ __ __ __ Final Inspection bY: Date " �k SAN JOAQUIN LOCAL HEALTH DISTRICT r 14 9: 1.'AR RPv_ SM