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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Perm----------------------------------------------- itr ----------------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued -- j Application is hereby made to the San Joaquin Local.Nealth;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/LOCATION -_�,fCENSUS TRACT Owner's Name g' 1.5 �� .5•.fiS�1----------------------------------------- --------------Phone------------------------------------- Address ----- Z-9- ----------------------------- --- City r Contractor's Name .. 1- --! ; _.License #� /�. --_- Phone _ �� .0•y f Installation will serve: Residerice Apartment House[3 Commercial:❑Trailer Court ❑ x j Motel []Other --------------------------- ---------------- Number of living units:--- ------ Number of bedrooms .1-------Garbage Grinder .----------- Lot Size ater,.Supply: Public System and name ------------------_.-_-_- Private y - ---------------- -------------- -- Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam .0 Hardpan ❑ AdobeX Fill Material ------------ If yes, type----------------------------- (Plot plan, showing size of"lot, f cation of system in relation to wells, buildings, etc. must be placed on rever NEW INSTALLATION: se side.} t - '' _ {No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT { ] SEPTIC TANK:[ ] Size-------- ----_-------- -- ------- Liquid Depth ___ - --__._--_- Ilk - Capacity ------ Type RX"611'-f T Material__ N Compartments i • r f•••--- Distan.. ..to nearest: Well -------------------- Foundation__�'Q___----__-- Prop. Line _-__- LEACHING LINE t [ ) No. of Lines ------�__-_------- Length of each line......' __- ------ Total Length 17C�-_--- D'9'Box: Type Filter Material X_7tt__---Depth Filter Material -------fff` .------------- Distance to nearest: Well -____--_-^i- Foundation _-._/'V------------- Property Line f SEEPAGE PIT [ ] Depth -_ ----- Diameter ` ---- Number Number -".-.----_il _-.�-_Rock Filled Yes No Water Table Depth -------6-0------------ --------------.--Rock Size �-.�------ yDistance to nearest: Well ___, � ---------------------Foundation ./.0-__--------- Prop. Line __ _______ REPAIR/ADDITION(Prev. Sanitation Permit#---------------.____ -------- Date Septic Tank (Specify Requirements) -------------=---------------------------------------- - Disposal Field (Specify Requirements) -----------------•------- -----------------------------------'- ------ ----------------------------------------- t (Draw-existing and required addition on reverse side) ; I hereby certify that 1• 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 Locdl.Heaith 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, lkshall not employ any person in such manner as to beco ject rkma 's CoCalifornia." r , pensation laws of �- Signed _ __ - ---------- - -- ----------- wrier BY -----R----------------------- --- Title y - ------ (If other t an r) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY 1 ----- ------------ '.f DATE f . -. - BUILDING PERMIT ISSUED. ------------------------------ - - (- DATE •----- ADDITIONAL COMMENTS =-------------------� - t ., , .r � ► ;------------------------------------------------- --- - --------- -- - ------------------- .-. -------------- s --- -----------Date ---- --- Final Inspection by: 1 --------- SAN JOAQUIN- LOCAL HEALTH DISTRICT ! �; r { �L ;