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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. .7...�........... t 1 . t......................................................... This Permit Expires 1 Year From Dote Issued Date Issued .91�"7 Application is hereby made to the San Joaquin Local Health District for a permit to construct andrinstall the work hereir described.This.applicotion is,made in compliance with County Ordinance No. 549 and existing Rules and Regulations. JOB ADDRESS/LOCA N . . .Al.. H.! .. ..�1....`?` ! pCENSUS TRACT Owner's Nome ,,rt c.. r"_. _•' _._., . _ _._., r, ._ .... i ..................: ................ :. ._........._Phone .................................... Address ....__. �. 7cF_ CI �-. . 4` .. Contractor's Name .... -ter_ _ ____ ________•--._, �•,,,, •••- „:,-•-•License # ,�� c�' -^:.. Phone Installation will serve: Residence❑Apartmen use❑ Commercial ❑Trailer Court t I Motel ❑Other ....._ .._- -. .............. Number of living units:............ Number of bedrooms ............Garbage Grinder ............ Lot Size ............................................ Water Supply: Public System and name ...................................................................... .........................................Private to ('J Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay [ Peat❑ Sandy Loam O Clay Loam ❑ Hardpan Adobe'❑ Fill Material ............ If yes,type;............................ (Plot pion, showing size of lot, location of. system in relation to wells, buildings, etc. must be placed on reverse side.) I NEW INSTALLATION: (No septiconk or seepage pit.permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK; J Size................................................ Liquid Depth .......................... j Capacity ..................... Type Material...................... No. Compartments Distance to nearest: Well ....................................Foundation ...................... Prop. line - ..•.••. F ...._................. 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 [ J Depth ......:............. Diameter . Number ............................ Rock Filled Yes ❑ No (� Water Table Depth ...................................... ......Rock Size ................................ Distance{to nearest: Well ........................................Foundation .................... Prop. Line ....................... REPAIR/ADDITION(Preys Sanitation Permit# ................................... ° ;.. Date ..............................:...) Septic Tank (Specify RequRements) ................... .. ............................. Disposal Field (Specify Requirements) - - ... ..... . ....... .... �.... "X ... ........-•......................:...::.....,.....__._._....-------._... ........................ ... ..._.._........ ✓.._.. ` ..._ _... __ A(Draw existing and required addition on reverse side) S I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State1aws, 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 sholl not employ any person in such manner as to become subjectto Wo ants Compensation laws'of California." Signed ............................ . .... ......... ... ... ....... ..... _ ....................... Owner 8y ............................. :.:.. .. A� ....... Title .. �...._. !!`.......................................... (If other than owner) U FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY............. : ....._.........__.................._...__._..__............__........__...._.. DATE .._....._�_.l/.. _.93.................................... BUILDING PERMIT ISSUED .. .. .... .r .. ..... ............. DATE ADDITIONALCOMMENT......_�. .............. ......................................................................... ............... ................,.+.c ............................... ....... ......................................................... . . ... ................ / ----:......---.............._......---..................---._.............. ..._...... .......I....... FinalInspection ... .. .......................................................................................Date .......9.:/..l .................. SAN JOAQUIN LOCAL' HEALTH DISTRICT