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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .............................•................ ..7. ... (Complete in Triplicate) Permit No. 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. 549_and existing Rules_and Regulations: JOS ADDRESS/LOCATION .. •-��_... ,�ti.-. :............. ' Sl+.7RACY ..... �.?�.'c8t� e.:.......... ........ •......... .............Phone...................................... Owner's Name ..... Address ........... .. ---.. ... .. ...._... u ................ City .... ..........................` j.............................. Contractor's Name ................ ._- ...:.G .. ? .....-.License # .. �� Pone ...::::.................... Installation will serve: Residence (Apartment House fl Comm ercia ❑Trailer Court 0 Motel ❑ Other . :..... �_. Number of living units:.... Number of bedrooms ...../_Garbage Grinder............. lot Size ...........�.` Water Supply: Public System and name ........................................................._......................................................Private { �� Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat Sandy Loam Clay loam ❑ Hardpan Q 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 p blic sewer is available within 200 feet,) PACKAGE TREATMENT [ } SEPTIC TANK[� Size...`f �.._.� ._ -� '_... 5...--..Liquid Depth �.................. �.. ; Capacity /.c �. ..... Type_ _,/ -, - Material.... �:_. No. Compartments ~........: Distance to nearest: Well ...........S.' ................Foundation .....1._!~?............. Prop. Line ...cY.............�. LEACHING LINE [-r,"No. of Lines ..`...7 ........ Length of each line a _.__.. Total- Length _. .`� .. 'D' Box ..__ TYP e Filter Material ....5._�r'~ _-Depth Filter Material ...._.1_�1.��...:..................... - - Distance to nearest; Well ...:..SP.....:.:::... Foundation ....1-.a.._..:...... Property Line ...I-S.................. � SEEPAGE PIT [ ) Depth Diameter .. Number ..... Rock Filled Yes ❑ No IQ Water Table Depth •................ .... ......._Rock.Size .._................................ .... .... ..:.. Distance to nearest: Well .Foundation ......... Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# ....-••._•.•..__:. Date .................::...........:.(I r SepticTank (Specify Requirements) ...........................:..........................................................................._.............................. •.Disposol Field (Specify Requirements) ..........:.............:...• .----••--___._..--------....__._.__..---...............;__......_................. ..................._............................................. _....•:••--..:.......------..._......---_____._.........._--.-•_._ :-•........................................... . ,.....y .. , . (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and fhat'the'work will be done in accordance with Son 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 ..........................:........-- .............. .......... wne By .. Ole . r .. .......... .... .. ..........................: (If other than owner) y , FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY �t�'`t ........:......:..........•--...._........ ......:_.....:. DATE :.I...Q..... _L.._...7. BUILDING PERMIT ISSUED ..........--• ......._ ..... ..... ....................... :_. DATE .. ADDITIONAL COMMENTS ..-•-...................................................................:.............:.....................:...........:....:..:.'.......::............................. . . , r Final Inspection by: / SAN JOAQUIN LOCAL HEALTH DISTRICT .i