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�; <.. FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No•7,f-!�,—//4 ... (Complete in Triplicate) , ------------------...................-----_ Date _-_-...-----•.,-..-- This Permit Expires 1 Year From Date Issued Application is hereby made to.the San Joaquin Local Health District for a permit to construct and.install the work herein describes This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: 4 �A 'rENSUS TRACT......_-:' JOB ADDRESS/LOCATION. �. /�.d"�. ---- ••-•--. ... ... D/1--.�P�...........:........• ; .4 Q� l ....>;..._.._ Phone.................: ................. Owner's Name....... . ` . .... .. P : •---- . .......Address.... . .... ... .. y....- ... r , License # y�� Phone. 1•.'.'�� Contractor's Name.......U��' - .Wit:- ........................ Installation will serve: Residence /Apartment House E] Commercial F] Trailer Court ❑ , Motel ❑ Other................. y Number of living units:..._ Number of bedrooms-,i... - Garbage Grind1.er. S---Lot Size_ -....lam- ....... ..-• -- a .--- Water Supply: Public System and name._ . _-------._ . . --... ------- -•------- .............. : - -_+riva� .................... ... .... to Character of soil to a depth of 3 feet: Sand ❑ Silt Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ill 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: (Noe'septic tank or seepage pit permitted if public sewer is available within 200¢feet,] r PACKAGE TREATMENT [ ] SEPTIC TANK [ ) Size................... ..----.-...'...........`'4.......__...Liquid .............. Capacity._.. ....... ......Type............. -......matwial.. ....................... No. Compartment's...........,...........:........ Distance to nearest: Well. .. ....... ..-:---•.Foundation:.:_: _..... _. . ...Prop. Line._:..........••-•----• LEACHING LINE [ ] No. of Lines_..............:............Length of each line....... ":""' ...."Tatal'Length ............ 'D' Box. ..........Type Filter Material...................Depth Filter Material ................-. .......................................... Distance to nearest: Well........................ Foundation------------------..........Property Line................................. SEEPAGE PIT ( ] Depth.. :... Diameter....................Number................................ Rock Filled Yes (] No WaterTable Depth. •..•------------------------- ---- - ----- -----------Rock Size.-_.......... .....__..... ..................• Distance to nearest: We'd. -: -------------------•--Foundation......_........__......_.Prop. Line.................. . REPAIR/ADDITION (Prev. Sanitation Permit#....... .......::..'.' ............. .....-.._..._..Date.___........_.--.-._....-__.,-...,..-- ) Septic Tank (Specify Requirements)--- ............. .................................. .................... . r �......... I Disposal Field (Specify Requirements].......... .. ``'.._.. ., ..... 1D._X.—Ac101 ..... _.. r ....... . ..... .i.�. ..� ..:5 .._s ...., ._.------•----- - ---------- ... ----.-_._... -------------------------- -- .... ....-- (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 Cout i Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed age 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 Jo become subject to Ton's C e tion laws of California." ' }:f, L. Signed.----••................ ( __ Owner r r �— ....-- ---. ... .... . ... f.. fl" ....---• . ...--- Tale.. .. " BY S. ._ i 1 (If other than owner}' FOR DEPARTMENT USE ONLY APPLICATION,ACCEPTED BY...... t.. . ..__:_ ... ..:' TE ................................ ......_......._._........�.......__.:.DA '.. _ w✓ Z. / DIVISION OF LAND NUMBER... --. ........ ..DATE... ._:._._..... ......,,........---._...... ADDITIONAL COMMENTS.................... ...... ................................._.__._... ................................................. ............. _..... ' ............ ......... •-----•--•--. Final lnsoection bv: �1__._ ... .:.. =:__. 5_:... --•-•• Date. / �. ..