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FOR-OFFICE USE: APPLICATION FOR SANITATION KRMIT - Permit No. ....... - {Complete in Triplicate} rr 7 ........................................ Date issued -b..� y:-•-• This Permit Expi-es 1 Year From Date issued Application is hereby made to the San Joaquin Local Health District for a parmit to construct and install '.he work herail. described.This application is made in compliance with County Ordnance No. 549 and existing Rules and Regulations: bi. JOB ADDRESS/LOCATION .I !'v - d'1 �r.7.. .. .'............ .. . .....CENSUS TRACT ..._._..............•.... fr�Sr?� .Phone`N "S' ' Owner's Name . ..._ . .. ... .... Address ...._-..... 51. '�••: •-•---• -•--.._..- _ ... bDs�.`.......... °hone .d...16� Contractor's Name.......-.-- --- . . ................Licen se l_ . .. . Installation will serve: Residence❑Apartment House'(_] Commercial 97,railer Court [� �* T i Motel F1 Other......7:45. ........ Number.of living units:........._. Number of bedrooms .........___Garbage Grinder .__.. Lot Size .............. . Water.Supply: Public System and name .................... Private❑ Character"of.soil to a depth of 3 feet: Sand o Silt j] Clay [D Peat❑ Sandy Loom [3 Clay Loam []... Hardpan Adobe 0 Fill Materia! _...........1f yes,type..----.... ............... IN plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed-on reverse side.] 4 p : NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 204 feet,) PACKAGE TP';ATMENT [ ] SEPTlC.7ANlC[ ] Size...................................... ......... Liquid Depth ..... . .. .... .. ......... .. Capacity ...... Type ...............•... Material .. No. Compartments ... . . _ Distance to nearest: Well .............. Foundation ........ Prop. Line . - #. ...... Length of each line ..... .................... Total Length ... LEACHING LINE ( y No. of Lines ..................... .. g --- �— .Depth Filter `raterial --------•........ .. 'D' Box .-----...-.. Type Fitter Material ................... Pro Line Distance to nearest; Wel! ........................ Foundation . -- pa SEEPAGE PIT [:.]' Depth Diameter Rock Filled Yes No Number --•-- ❑ Water Table Depth Rock Size .--------.-- ••.•-- ... ...... ........ ....................................... Foundation .-....--•---•-•-.._- Prop. Line Distance to nearest: Well ............................ - - ' REPAIR/ADDITION(Prev. Sanitation Permit# ........... Date ..................................} _ ..... Septic Tank (Specify Requirements) .... . .................... ��, ........... .. Disposal Field f5pedfy 'tequ�rements) __..... -••-• V . ......x-.�-.�-..._._.. _: . .:... r ...................... (Draw existing and required addition on reverse side) I hereby certify that l have prepared this application and that the work will be done in accordance with Son_.. IlCeJoaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner aI[cen- sed agents iignature.certifies the following: "i certify that in the performance of the work for which this perrnit is issued, I she!! not employ any person in sucF.manner as'to become subject to Workman's Compensation laws of California." Signed ................ Owner { �I�?C .. .. .... Title - -...... - - j .... �f r x (If other n owner} FOR DEPARTMENT USE ONL �— - - . .' .._... DATE .. ... APPLICATION ACCEPTED 8Y .DATE ..-- �... .. _ BUILDING PERMIT-ISSUED . �.. ....... , ADDITIONAL COMMENTS , .... ....... . ... . .' .............., Y1 .. -e .. ....... -� .=� Final Inspection by. � l.. - .. Date � .. ...- 1. .. ... SAN JOAQUIN LOCAL HEALTH_3STRICT E.H. 9 l-'66 Rev. 5M