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POR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. _L... This Permit Expires 1 Year From Date Issued Date issued ..... Application is hereby made to the San Joaquin Local Health District for o 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 //��>U _ CENSUS TRACT _.......... �� Owner's Name �:. _. �... ... . Phone ....... Owner's bw Address ��GJ .... . - .- - ----...... City . _ .... Contractors Name . B?�c--ij - ._ -..license # >`f J'f .._ Phone Installation will serve: Residence Apartment House-❑ Commercial ❑Trailer Court60 ❑ Motel F-1 Other ------------- , Number of living units: f Number of bedrooms ..13.-.Garbage Grinder Lot Size _ j 7- . ... ..... in Water Supply: Public System and name ._..... _ _ _..Private Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ S , Hardpan k 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.... _-------- _ Liquid Depth . _. --------------- ' Capacity I Type Material.... . No. Compartments .. .................. �• Distance to nearest: Well ....... ......Foundation ... Prop. Line .-.-.. ...... LEACHING LINE [ ] No. of Lines Length of each line Total Length .-.. _ _--- ..._. 'D' Box Type Filter Material _- ----- ......Depth Filter Material ... . ..... ................. .... s Distance to nearest: Well . . _.. __._ Foundation Property Line ..... _._............. SEEPAGE PIT ( ] Depth . Diameter ------------- -- Number Rock Filled Yes ❑ No .. Water Table Depth .. ..._. . ................................Rock Size . . ......- --. . Distance to nearest: Well ................Foundation - _ Prop. Line -- (Prev. Sanitation Permit# -------- -_ Date ._.. .. _ --------------------) r Septic Tank (Specify Requirements) _. . ..... .. Disposal Field (Specify Requirements) .. .... ----------------- . .............!-i 0 -c-f- r (Dra'w existing and required addition on reverse side) r, 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 rr as to become subject to Workman's Compensation laws of California." Signed ------ Owner - _. . ._._ BY ��%W� '.' .. `!'�� - . title r . (If other th n owner) FOR DEPARTMENT USE ONLY INN APPLICATION ACCEPTED BY _ DATE _ BUILDING PERMIT ISSUED DATE J ADDITIONAL COMMENTS _ Final Inspection by: �.. ,. . . . Date i,., SAN JOAQUIN LOCAL HEALTH DISTRICT