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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - _ _..............•--•---..-.-.._...... py o (Complete in Triplicate) Permit No. ...... This Permit Expires IYew From Daissued Date Issued Onto Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work hereir described.This application is made in compliance with County Ordi nce No.549 and existing Rules and Regulations: JOB ADDRESS/LOCATI �Bo ._ .- ...:.. _..._...__. 'Y.t/..... ..-..CENSUS TRACT s.I`...�.------• Owner's Name ._.:__�r9-..__ .. . ............._.__.__-.,....-._...--... .....-.--.......Ph ne...-..-....._-.:_....- _----___-_'. /�/� - .. .................—----------- `. p c C ontra,rtor's Name .... - - .-.-_ ... ._._.License#<pdt 3dr--Phone. _.-_-....... Installation will serve: Residence Apartment Houser]Commercial OTraller Court r] Motel❑Other.................................. _ Number of living units: I..Number of bedrooms 5:,.Z Garbage GrinderSize ... _ •- Z � _ Water Supply:Public System and name::_._.__-•-..._.........._........_..........._......._....-..__.-....... .-:._...---..Private_J Character of soil to a depth of l feet: Sand]] Silt❑ Clay o Peat❑ Sandy loam Clay Loam 0 Hardpan❑' Adobe-0 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[j Size............................................. Liquid Depth..........-----_..------• Capacity - ----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 ................-................._...... Distance to nearest:Well........................Foundation ........................ Property Line ....... SEEPAGE PIT ( ) Depth Diameter ................ Number ............................ Rock Filled Yes ❑ No 0 Water TableDepth ..........................-_._____.........Rock Size-._..... ..................... Distance to nearest--Well.........................................Foundation .................... Prop. Line.........._..... REPAIR/ADDITION(Prev.Sanitation Permir#..........................._......_..-...Date.:.-.. .._-..-...- f Septic Tank(Specify Requirements)........_:..._ _. Disposal Feld (Specify Fequirements) .-_ -•- - ""'' _ ... ------------ ...............................-----.................................................................................................... .............. ...._...---.--•----........... - .---..................._..-.._-......--•-•................................................-....---._ _...... (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be den* in accordance with San Joaquin County Ordinances,State Laws,and Rules and Regulations of the Son 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 net employ any person in such manner as to become bled to Workman's Co nsation laws of California." - Signed.......-.. -_ _ Owner _.... By._...... -. ..-...�_................... ....... Title..�-.................-............... (if other than owner] ...... ,,.----'FOR-DEPARTMENT,LISE ONLY APPLICATION ACCEPTED BY ................._................DATP,..r..,...�..._...,.-.c-....._.. BUILDING PERMIT !SSUED ... - ---- --__.................. ------__ ..........-.DATE ADDITIONAL COMMENTS ... _. ............... ... _... ... .. . .. .- ��-�� . Fnal Inspection by:. _. y C�<Qi. �_. -.� .. .. ...... ... ......... ....... Date. ...`..-. ............ '*a SAN JOAQUIN LOCAL HEALTH DISTRICT E.H.9 1-•64 Rev-5M