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un vrr-i-.� vac: PPLICATION FOR SANITATION P"IT Permit No. �:........� (Complete in Triplicate) -- ------------------------------------------------• This Permit Expires 1 Year 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 made in compliance_ with 'County Ordinance No. 544 and existing Rules and Regulations- JOB ADDRESS/LOCATION .. ... -_...._ ;. ..----... .-- ................................CENSUS TRACT .......................... Owner's Name - -------------- --- - ----- -- -----------�- -------------:......_......... .. . ..... ..Phone .................................. Address ......... ..................... Contractor's Name .- - (.--- - _ .4-!eQ---..License # ..lOU3 a Phone .............................. - , Installation will serve: Resid ce Apartment House Commercial-❑Trailer Court '❑ Motel ❑Other ............................................ Number of living units:.......... Nuo4iber of-bedrooms ...._Garbage Grinder ...1. Lot Size Water Supply: Public System and name .............. ..........._..Private 0� Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam lay loam 0 + ` Hardpan 0 Adobe t] Fill Material If yes,type ............... ............ V {Plot plan, showing size of lot, location of system in relation. to wells, buildings, etc. must be placed on reverse s(de.,-,� NEW INSTALLATION: (No septic tank or.seepage pit permitted-.if public sewer is available within 208 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK,I�.] Size...°..:.....................I................... Liquid Depth. .......................... Capacity __._ v yPn . =Material.......... ... ........ No. Compartments .y . .: . ...................... Distance to nearest: Well _...................... ............Foundation ...................... Prop. Line ......................� LEACHING LINE t J No. of Lines ________________________ Length of each line._-._._...______.._...__._._ Total Length V Box Type filter Material ....Depth .Filter Material ......................................... Distance to nearest: Well ........_........_.. ... Foundation ........................ Property Line .............. SEEPAGE ] Depth_------------ -----=--Diameter-_--------------- Nuiriber ...................1-1 Rock Filled Yes ❑ No Water Table Depth ----------------- ....... ---.....Rack Size ------------------•------------- Distance to nearest: Well ........................................Foundation .--.....__ ......... Prop. Line ...................... REPAIR/ADDITION 1Prev. Sanitation Permit# --------------- =------------- Date------------ •--------•--------I r. . Septic Tank (Specify Requirements) ___:--------- ---- - ------ ......................------------------------------•-------. _... ,mss. ..---------- - Disposal Field (Specify Requirements) ---- ,._ ................. . . - _. --- --••----------------------------- ---- ------------------•----•------------ - ---------- ---•--------...__._.._..--- .--------.---_-------...- {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 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 to such manner: as to become subject to Workman's Compensati laws of California." ... ------------ SignedOwner BY ----- ------ -------- �! ... •-- Title ....... _. _ (if o#her than o rl FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------------- ` ----------------- ---•-------•-- ------ ---- -- ------- --------------- DATE ..:7 ..... . . BUILDING PERMIT ISSUED -------------------- - - .......................... -. .......DATE ..... ---.----- - ADDITIONAL COMMENTS .._ --------------------------------- --------------------------- ................. -------- ------- _.---- - - - .-------------------------------------------- -- --------- ---.._..............-......---------..._....-----.... . .._.. .......... - -------- ----- ---------•--•-•-----•---- Final Inspection by: — ...Date -- ------•- 3 21t -6 Iiev, 5m SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M