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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -- --- - (Complete in Triplicate) Permit No. .. ... .......... __.-.-. _......_................................... ..........-........__................ .......... This Permit Expires 1 Year From Date Issued Date Issued .. .".....�7. 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: JOB ADDRESS/LOCATION ............ CENSUS TRACT -...�.y �A Owner's Name .......HCl...'."..:........ ... cc .... • -- Phone .................................... Address _.... r��.I..j..�..... ..ca/.'" :. :. :G::....�: .�- _.... City ...... � Contractor's Name .... e� _r '.yLC s lei.:....License # /599 44hone .............................. . Installation will serve: Residence Apartment House❑ Commercial❑Trailer Court 0 Motel ❑Other .............................—............ Number of living units:......!.... Number of bedrooms ----yGarbage Grinder ............ Lot Size ...... Water Supply: Public System and name ...-------------------.............. _..-................................................Private a Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam [5� Clay Loam ❑ Hardpan ❑ 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 see pit permitted if public sewer is available within 200 feet,) , PACKAGE TREATMENT [ ) SEPTIC TANK T/I ZSize..ttA , ! 'Y-_d..`--------._-_ !/� ---- Liquid Depth .... �: . -. .......1� TO : d no Capacity �yaa76tf.. Type C44A.vi„w...... Material-, :d)c.�...... No. Compartments ........2r ....... Distance to nearest: Well -...-.-...- �r?^ :-----.Foun-Y n ..--els'-!�i' . Prop. Line ..... LEACHING LINE [!] No. of Lines _......2............. Length of each line.-.- C-0............. Total Length -.. / 'D' Box ...—: --- Type Filter Material .... —7.......Depth Filter Material ........1..i.............................. Distance to nearest: Well .----.JC ...... Foundation ....AC Property Line .....-r''�----..__.. �. f 4 [/f Depth ./j -_-- 9iemete�._XJ4. /... Number -------�...__----.----_ Rock Filled Yes [� No ❑ IsO Water Table Depth .............9.f ..................Rock Size ---J.�,,a..X..,y'..�... Distance to nearest: Well ......_/4r?�...............Foundatian .✓ .... Prop. Line ...../ REPAIR/ADDITION(Prev. Sanitation Permit# ................... ---------.-------------. Date ..................................I SepticTank (Specify Requirements) -------- -----------------------.........-.....................----------------....----'-----------..........__..............-------- Disposal Field (Specify Requirements) ---- ----..................... ...--------------_--- ------ -----------___................................................. _---------.-------- ------- ------------- ---- ------ -------------...__-------------------------------------------------....................................... (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with San 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, I shall not employ any person in such manner —as to become subject to Workman's Compensation laws of California." Signed ................... Owner T /? Title - fi<<.. ... -- ------- (If other than owner) FOR DEPARTMENT USE ONLY `APPLICATION ACCEPTED B ... ° R ............................................ --------- . - ---•-_.... DATE ..c x..4 .-.7` .............. BUILDING PERMIT ISSUED .............. ............. .. ...............................---- -- ......------ ..............DATE ........................................... ADDITIONALCOMMENTS ---------------- -- -------------------------•--•---••------......------................................... .......................... __................ .. . ......___................................... -----------------------..--..............,----....---------•--------- ----...-•---•-----•------....-.-........ ---- ----------------------- -------------- - - - .i- Final Inspection by . ..s L... -. . Date . :df:.7�.... .......... V SAN JOAQUIN LOCAL HEALTH DISTRICT