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FOR OFFICE USE: APPLICATION FOR SANITATION PFv1T -- � Permit No. (Complete in Triplicate) This Permit Expires 1 Year From Date Issued Date Issued -__ -f-�.... Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein desgribed. Th' apglicati ncis made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LO T (�N.J / I 4"f S /� "`__Y`t- __CENSUS TRACT - - - Owner's Name __. _- _.. _--Phone .- _. _ ��--�y�=� // � - - - -- - 566_-_�,/�.� Address __..._ --..__ �. . ..-2*1,-1-- - - -- -- -- -- -- -- -. City ---------- -- -- � / c-- �j Contractor's Name --.- �-- e --...License #�00.�1/----.-- Phone cref �� -(.�TT-,/. - --- - - ----------------- Installation will serve: Residence ❑Apartment House❑ Commercial)(Trailer Court j] Motel ❑ Other Number of living units:______ Number of bedrooms -----_ ----.Garbage Grinder .. .... Lot Size ____-------------------------------_--.-.- ■. Water Supply: Public System and name ---_--------------j---`------- ---------------- --------_--------------.-------------------Private Character of soil to a depth.of 3 feet: Sand 0 Silt❑ - Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ----- If yes, type r (Plot plan, showing size of lot, location of system in relation to wells, build ngs, 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 i _.._ _-------------- Capacity ---.--.----- Ca acitY - _.._ Type - Material... No. Compartments ments -.. - - Distance ' `wN to nearest: Well _.-Founcidtion __._--------___. Prop. Line -.._-.----__.--._- LEACHING LINE [ ] No. of Lines .________-_.._ Length of each line ------ Total Length __----._--------------_. q 'D' Box ....... Type Filter _Material -=----- ---------Depth (Filter Material ..........---_- -------------------------- a Distance to nearest: Well ._ __.._...__'_-- Foundation --- --- Property Line ----__._--- .--.----- SEEPAGE PIT [ j Depth ..__... _..__.__-- Diameter Number .___- _--------- ------ Rock Filled Yes ❑ No [ ' Water Table Depth -----------------------------------------Rock Size ......... -------------------- Distance to nearest: Well ..__,._------------ ----Foundation -------.___ ----- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# -------- --------_-_________----- Date-----.------------------- ---------) Septic Tank (Specify Requirements) ---------------...._ ---------`-----`------------------ --------------------------------------------.. Disposal Field (Specify Requirements) ----- ------- - .. -._..-.. .- �___ -- ------ - --....- - - - -- ---'---'--'- =9� - ----- �_ - ---- v-- jam - ' --- --- (Draw existing and quired 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, 1 shall not employ any person in such manner +� as to become subject to Workman's Compensation laws of California." Signed � �7�-..._ ��---�-----��f ----- --- --. Owner By /.. —� - _-____ (` �1A - Title - ... . (If )f an owner) FOR DEPARTMENT,,USEq NLY APPLICATION ACCEPTED BY -- - - ------------------ - - - V -. DATE -ICS-G yr- ------...-- BUILDING PERMIT ISSUED ------------- ------ - - -. - - - - -----DATE .... --- -------------- - --------- ADDITIONAL COMMENTS - - - -- - - ----- -- - ---- - - -------- - -- --------- ---- --------- -------------- ---- - --------- -- - --- --- - -------------------------- - - .---- -- --- i'__-6 - - -- ------.._.. ---- -- - --- - Final Inspection by: ----------- ---------- -✓IS _.Date '?---- C��----yr---_ _ SAN, JOAQUIN LOC L ALTH DIS RICT