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N, % FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 74{ i......-.... � ._... ....._ Permit No: _...... ..~ (Complete in Triplicate) .................................................. This Permit Expires I_Year f=rom Date Issued Date Issued ..� _: Application is hereby made to the San Joaquin Local Health District fora permit,to"construct and install the work herein described. This application is mode in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ....R..l-. .. _ ._ Gl! .... .......... . ............................CENSUS TRACT .:.. ....:.....-:.... Owner's Name .�ef� 6 ---•......................:.....•--•-.....---...Phone .7�° .:... Address -..%57 6 e1: ........................•. City . .ai7 ?.._... ......... Contractor's Name ..-•, .................. _.....License # 1a1 Phone .•... .. ..... Installation will serve: -eResidence�Aportmen)House❑ Cbmmercial ❑Trailer Court C] Motel E]Other _....%........................I........... W or Number of living units:_.:-/.../Number.,of bedrooms .--Garbage Gr€nder,C1P-_ Lot Size , # ........ + Water Supply: Public System and�name ------------------------------------------------------..-.._--...................._._............................Private C� Character of soil to a depth of 3 feet: '-.Sand ❑, " Silt❑ Clay ❑ Peat❑Sandy Loam ❑ Clay Loam ❑ ..ti Hardpan,(] , AdobeX Fill Material ------ If yes--,-'type ......_.................._-. (Plot plan,-showing size of lot, location of. system,in relationto veils;buildings, etc: must-6e -placed on reverse side.) NEW INSTALL,•ATION: (No septic tank or seepage pt permitted if public sewer is available within 200 feet,) TR _u PACKAGE' E • IIATMENT [ ] .SEPTIC TANK t ] ��ize.----•-�-•.................�...._......._...... Liquid? Depth .......................... £� Capacity __- Type { 'fUlaterial No. Compartments [ Distance to nearest: Well ............................... _--Foundation ----------_--- ..... Prop. Line ..-_ ................. X ` , LEACHING.LINE [ ] No. of Lines __- Length of ea `"line._ " �" "� g ' .....-•-- -------- --- ---- •-----------•--.. Total-Lent ............................. 'D' Box _ Type Filter Material Depth`Filter Material ...........................:..: r Distance.to nearest.. Well _______________ Foundation ......... ------- Property Line ..............-_.-....... l:gSEEPAGE-PIT [ } Depth Diameter ................ Number ....................._..Rock Filled Yes ❑ No (] t Water "Cable Depth ........Rock Size ... Distance to nearest.• Well ........................................Foundation -•----._.._..._..... Proxp . -Line ................... I REPAIR/ADDITION(Prev. Sanitation"Permit# ....:......................................• Date .................................. Septic Tank (Specify Requirements) ......... ..- ;�.... ............ 1f Qisposal Fibld (Specify Requirements) •-- - - ... - -i�-��Jl• G, .. J ,. . ..:.......................................:.............................--------------------------- ---------------- --- ----- ----------------------------------••------------._-..---•----•------._..............................----•----•--...._..._-._....-----..I...... i (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: "E 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 By .. --•............. .._ ...' /� ��---•--....-----•---........_... .Title .. dt._._.. ....................... (If other an owner) - POR EPARTMENT USE;, ONLY APPLICATION ACCEPTED By ... ....._...... 1:1,11.4 .... ............................................. DATE Q.. .. .............. BUILDINGPERMIT ISSUED ............................•---•-...::___............--------------•------ ----•-DATE ............................................. ADDITIONALCOMMENTS ............................=-----•........------••-•--....--•--....---•- ...........I.....----------- --------------------- -----..._...---.. ......... ..........•----------------------------------•-..-•-••-----• --•---------------------------------•---------------------------------•---••••-•--------.._...._.................................---_-•--- ............. = Final Inspection b : ... __ `..................................- .........................................Date la ,/ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 1.3 241-'b8_Rev. 5M _ 7/7�-�2 3 M