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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT _ (Cornplete in Triplicate) Permit No, - ' """.....-••.•-•--••••--•--••,,........... This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to she 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: JOB ADDRESS/LOCATION -.3- Owner's Name x..5.4..!4...�� ............................. CENSUS TRACT ,,, - -._ r G t � -x,► a m.. Z 5 ..... ......... phone Address .3 6 3.,.. x .5.v v Cid - _. .. _ Contractor's Namek �� ,.\__�_ 1_ .. _ �'�� - License # C'. �'►' Phone . ----------------------- Installation will serve: Residence 5a Aportment House❑ Commercial ❑Trailer Court .© Mole!LL�J Other Number of Living units:..._------- Number of bedrooms _9.....Garbage Grinder ....... Lot Size ...v....................................... Water Supply; Public System and name ...:....................................................-.......-,y---- --Private Character of soil to a depth of 3 feet; Sand Silt 0 Clay ❑ Peat Q Sandy Loam $ Clay Loam Q Hardpan C Adobe ❑ Fill Material ............ If yes, type ............................ (Plot plan, showing size of lot, iocation of system in relation to wells, buildings, etc- must be placed on reverse side.) NIEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet] PACKAGE TREATMENT ( ] SEPTIC TANKSize.-•-----•------------------------- •- --_-._--_-. Liquid Depth ......................... (L� Capacity _- ------ Type �cami-•-- Material..C=thkAf.._ No. Compartments ---- � r Distance to nearest: Well ---------40()------------------Foundation _-.-----ta__.___-__ Prop. Line ._-_S-_-� / .,,....,. i LEACHING LINE [ J No. of Lines .__-_.__'Z-.___---_--. Length of each lime...........`10........... Total Length ..... D' Box ------------ Type Filter Material ----Q __-Depth Filter Material ---------ff------------ Distance -o nearest: Wel[ .....zS .O.---_-._- Foundation ------1L_o_*'------- Property Line _._ •--,.--.-_- 'SVtAG'"TTj"T Depth ........... ........ .....__ Diameter ...-..... Number .............. ,.. Rade Filled Yes ❑ No Q Water Table Depth --------- -------------------_.__-..Rock Size ------- ------------------- Distance to nearest: Well ------------------------_------__-__Foundation ._-_•___----------- Prop. Line .........--......-. REPAIR/ADDITION(Prev. Sanitation Permit#.......................................... Date Septic Tank (Specify.Requirements) ....----------------•-- Disposal Field (Specify Requirements] _.. •-------•--------------------------------------,...,.........-..----_--_._-._- ------------------------------------------ ----------•----•----•-----•--•---•---• ---------- ------ -----,---•--•---------------------------------------------------•------•------------•-- -_.-......__.--...........,..........._,--------•--•----------------_-----•--- •-- - (Draw existing and required addition on reverse side) I hereby eertify that 1 have prepared this application and that the work will be dens in accordance with San Joagpin County Ordinances, State Laws, and Rule: and Regulations of the San Joaquin Local Nealth District. Noone owner or 44e11- sod agents signature certifies the following: "! certify that in the performance of the work For which this permit is issued, I shall not employ any person in such returner as too sub] Workman � 's Compen tion Jaws of California." i . �Si ned .. .. J _•_ Owner l o 9y ..................... Title (If other than cwnerf FORD ARTMENT USE ONLY APPL[CgT(CN ACCEPTED SY -- ____yf=rt aurLOiNG PERMIT ISSUED - ----------------------------------- ....... .......... DATE �? ----------- ...._ .............. A.COITICNAL C •°- ----•...............:............•--•---•- .--------•DAT1= Fano%trrsaecrTcn bv: -- - Vie,. __.......... ...... ..... .... . ... ................... .............. .. ........... -SAN :OAQ(JIN - -,.-- - • .Dale . --_ =........ . .,_. LOCAL gEAl.TH DISTRICT ' y I-"6A Qa„ e..