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i r FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT l ................. ........................ .. �...�-'---•--� (Complete in Triplicate) Permit Na. This Permit Expires 1 Year From Date IssuedDate IssuecI4.:�::2i 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 ADDRESS/LOCA TI N ...... ..01 __- . .L�, r'`" --•-- ..._...'CENSUS TRACT .......................... Owner's Name ------- ------------- Phone . -- -_... - �l .... Address ��-��.. ._..-_ �: � .- -- - -- _� ! City . � .�'. .................................... Contractor's Name ' - -��..-. -.License dt Phone �. .. Installation will serve: Residence I°Apartment House❑ Commercial [7]Trailer Court 0 Motel ❑Other ---- -- - -- --- ------ ................... Number of living units:.. .- Number of bedrooms .......Garbage Grinder .`--62-4— lot Size _. ....... � � I Water Supply: Public System and name . .. � �..�s .4 ..... .. .-.----•----------------------_--_.._-----.__...Private,, Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan Adobe ❑ Fill Material 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 seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT SEPTIC TANK' Size. l '` ��............. ..... Liquid Depth .��y..._._._....._....� Capacity/0/406o!!i/Type .14 4604 Material.. Compartments -�- ..._ P _ Distance to nearest. Well rLine/,,N _.r V �( ... ..................Foundation.. f .._......... Prop. Line -;!'�-__..•.... LEACHING LINE No. of Lines J Length of egch line Total Length _/c .11 'D' Box . f' Type Filter Material .. . - ____---Depth Filter Material ...!`� -------------------- (11 Distance to nearest: Wel! .,/OC7._.'`.._.. Foundation ,�67__�........ Property line 4J................. SEEPAGE PIT rV, Depth �� ... Diameter a� ........ Number ..,7:.. .............. Rock Filled Yes dA, No Water Table Depth --....1. ..r--•--------•--•-----•----_-Rock Size Distance to nearest: Well ---------------------Foundation ....... Prop. Line .. ......... REPAIR/ADDITION(Prey. Sanitation Permit# --._._.. _.. ........ ..................... Date ---------------.--•-..............) Septic Tank (Specify Requirements] - ............... ......• ------------......... .� Disposal Field (Specify Requirements) --------------------------------- -- -------- ------• ---..... .- .... ........ ._.. .. ----- --- ------ ......................................... ..........................._.._.--.. .... . ---...... ------- (Dra'w 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,-11 shall net employ any person in such manner as to became subject to Workman's Compensation laws of California." Signed . .......... _1-- Owner Title wvilzo;lt;er than er) F,OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . ../ � .. . __ ... _ _.. .. ... DATE - ."7 _..._...... BUILDING PERMIT ISSUED :..- ------.DATE . ...........--------.....__._.._...... ADDITIONAL COMMENTS .... ........ ..._ISSUED .. . ••------ _..... .................•-----.. ._....._-.._........-- ........... -,- ---------- .............................. ....................................... ...__._.._. y Final Ins ecti ----- --- - •----•- --- _. ..... _ ............................... ........ ....-----•............. SAN JOAQUIN LOCAL HEALTH DISTRICT 13 24 -', 8 Rev. SM 7/723m_ _ 1=, ! -- --