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M FOR OFFICE USE: G ... .. APPLICATION FOR SANITATION' PERMIT r�✓� No....,........ (Completeln Triplicate) Permit ............ This Permit Expires T Yenr From Date Issued 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 mode in compliance with County Ordinance No. 549 and existing Rules and Regulatlonst JOB ADURESSAOCATIO . f � . ....CV1%US TRACT .... ........ Owner's NamePhone . .:...... 'Address City _ .... .... ..... .. Contractor's Name-- --. ........... ... .......License /J f._. Phone Installation will serve: Residence partment House f] Commercial OTreiler Court ? Motel©Other..- ......._...................I.......... Number of living units:.. ....X.. Number of bedrooms ....._0::Garbage Grinder ... ...:.. Lot Size ... ....... .... .... ................ 's Water Supply: Public System and name .................... .......... ---...--- ............................ ......................Private r Character of soil to a depth of 3 feet: Sand 1Wl Silt 0 Clay C7 Peat❑ Sandy Loam Q Clay Loam 0 Hardpan 0 Adobe Fill Material 1�...if yes,type aj (Plot plan, showing s;ze of lot, location of system in rotation to wells, buildings, c must be placed on reverse side.)`t NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is ovaaable wlthin 200 feet,) PACKAGE TREATMCNT [ ] SEPTIC TANK( ] Size.......................................... Liquid Depth Capacity ... Type ..... Material............ ...... No.: Compartments ) , Distance to rtearesr: Well -- . Foundation •..- Prop. Line...................... LEACHING LINE No. of Lines Eeng)h of each line Total Length gh 'D' Box ...... ..... Type Filter Material ...... .............Depth Filter Material ..........................................14b 4 Distance to nearest: Well ........................ Foundation .. ................. Property Line 's SEEPAGE PIT j j Depth .._... Diameter ................ Number .......... Rock Filled Yes L7 No C]F . w �.. Water Table Depth ----.................................... .....-.Rock Size.........._._..._...... ........ u s� Distance to nearest: Well ..................... ..Foundation . Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# ................. . . ...... Date ._....... ........................ Septic Tank (Specify Requirements) ........ .............. . ................................ _..�............ r, Disposal Field (specify Requirements j ........... yc;� � ... .. .�lr�' ........ /...' /f............ I .... ........... .. . ......................... ...../ .................... ................. ................. ................................ ....... (Draw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will b* 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: ,'. "1 rertify 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 ; s L/l. . ............ Title .... By_... ......... .... -.. ..... .---. .. . . . . = if her than owned a FOR DEPART�EN? USE.ONLY ; APPLICATION ACCEPTED BY RATE .. ...:T�L...... BUILDING ...- - - - r. . c�.. .. .... DATE IDING PERMIT ISSUED /... ....._.. �. .....�. .... . ... / �., /l.. ................ ... . ADDITIONAL COMMENTS ,. .. . . . ... . ..... �. �G r� - ., Final Enspedion by. ..` ,�'/� .Date ©l 13 A 1--h`i kv-, 5Al' SAN .;CAQUIN LOCAL HEALTH DISTRICT 8/711 3M ✓ r, Vt ��