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FOR OFFICE USE: Ai— CATION FOR SANITATION PERMIT Permit No .............................................. (Complete In Triplicate) . .......... ..... This Permit Expires 1 Year From Date Issued Date Issued .kpplicotion is hereby made to the San Joaquin local Health District for a permit to construct and install the work herein 'escribed. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: .dB ADDRESSAOC TION J� .. .................. ......CENSUS TRACT ........ )wner's Name .... -- --- -• . --- ...._.Phone .�•�-..-- - . ..�•----- dress ...............- �J .. •-----• •--.... City --•-- _ ontractor s Name -.---_ ............... ------- ----.-...License # rf ----- Phone .. �b- Q� tollation will serve: Residence Apartment House fl Commercial (]Trailer Court j] Motel ❑Other . umber of living units:..../_-Number of-bedrooms 3___Garbage Grinder lot Size .��.•x � ..--- _._ _. .. !_=l_-_-Q . iter Supply: Public System and name ................._... Private harocter of soil to a depth of 3 feet: Sand Silt E] Clay C] Peat❑ Sandy Loam ❑ Clay Loam 0 -"Hardpan [j --Adobe- Fill Material ........._ If yes, type ........................... W lot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) -W INSTALLATION: ;(No septic tank or seepage pit permitted ifpublic sewer is available within 200 feet,) _ZKAGE TREATMENT J j SEPTIC TANK i j _Size_.--""__.................................. Liquid Depth .......................... :Capacity ------.--------..... Type .................... Ma erial...:-_._._..::__ _.:. No. Compartments ;Distance to nearest: Well ---------_----------_-------1.......Found ation ...................... Prop. line ...................... ACHING LINE [ ) .�No.-of-Lines�__.�.:__ :'. :._____. length-oVeachj line._fi...... ........ .. Total Length 'D' Box ............ Type Filter Material ..... ........Depth Filter Material ........................................... Distance to nearest: Well ............i-------. ..;-IFoundation -----------------------• Property Line ................_....... :EPAGE PIT ) Depth ......... . .. `-/,.:i_. Number ---•-- -------- - -----•-- R Rock Filled Yes No Water Table Depth ....... it- ' =• L---`-------------------Rock Size . Distance to nearest: V1811 ..:------- ..................Foundation ..................... Prop. Line "AIR/ADDITION(Prev.i Sanitation Permit,#_ • ---•- -•- ; - - - -- Date ------- ..............--- t - eptic Tank (Specify Requirements) ----- . -•--•• EIhc� "u`i- l04!'� _.. 7- Disposal Field (Specify Requirements) _____________ __ -___- - ; / „c �ct t. V by ........................ (Draw existing and required addition on reverse side) reby certify that 1 have prepared-this application--and that-the work will be done in; accordance with San Joaquin ,nty Ordinances, State Laws, and Rules anJ Regulations of the San Joaquin Local Health District. Home owner or licen- d agents signature certifies the following: ertify that in the performance of the work for which this permit is issued, I shall not em?loy any person in such manner ,o become subject to Workman's'Compensation laws o liforni.a,'�,_ fined .•-- •--- . " --- --- .. Owner ----• --- --... ....-•-•-.....•---•-.. Title --•- •- - ------•----- ;.-------•-------•- - --- ... iI -......i.. - -- If o he t an owner)" FjoIb�DEPARTMENT USE ONLY LICATION ACCEP D BY ..... .. '— // :.......:........... DAT -----•.---•---- TcDING PERMIT ISSUED ...•..-• ..)DlTIONAL COMMENTS iA .................................... .................��• ........... .................. -•---------------------•------- ------•- e� i ial Inspection by: ..�":. • - _. . .. ... - ........................................Date _...1 / ._ SAN-•JOAQUIN LOCAL HEALTH DISTRICT L, t�