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FOR OFFICE USE: APPLICATION FOR SANITATION PERIMIT (Complete in Triplicate) Permit No. ..........- ............---------- ---------- ----- --- - -------------------••------•............ _-_.. This Permit Expires t Year From Date Issued Date Issued 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 comp lianc with Co nt Or once No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATIONUT/ ....U�l�-.. �rA ',Q_---_ O, ....CENSUS TRACT .... .. n Owner's Name r�.-.�..�_../�/ !P%/ST/ /............. .............. ........ .................... .....Phone . 16�i+`.`'..T�4��2 Address ............ City .. . %C?GJIj'E �. ... Contractor's Name _.1 ��T'1,�1�, S�l ��E. -.-.Zit/G..............License # ,�3?r1�.73..._ Phone ....4/�./-.%9 Installation will serve: Residence ❑Apartment House❑ Commercial ❑Trailer Court ❑ Motel ❑Other . . !. .�if'.................. Number of living units: . ----- Number of bedrooms -_ -------Garbage Grinder ............ Lot Size ....f�c' ,P/ G . Water Supply: Public System and name ............. .............................................................................._................Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ 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 seepage pit permitted if public sewer is available within 200 feet,) s PACKAGE TREATMENT [ ] SEPTIC TANK t ] Size-_-.- Ar?.. ............... Liquid Depth ...I...... . ....... W Capacity %�L' 6WType PPLO`C �Material_CtW.55<�'�j� No. Compartments ......Z:........... Distance to nearest: Well _.._70e9 �....._ Prop. line .....S.--------•-------------- -Foundation - --�Q..._ s ......... N i O LEACHING LINE [ ] No. of Lines _.-_ _ -.___._...__ Length of each line..-.__.:��-__.._..... Tata! Length ---:3'�t-..�............. . 'D' Box .--� _.. Type f=ilter Material Depth Filter Material .....----------�.�_...__._J........... Distance to nearest: Well _304 .l........ Foundation Property Line ..........�� ............ SEEPAGE PIT [ J Depth .-_- ----- Diameter ................ Number ............................ Rock Filled Yes ❑ No Cl) Water Table Depth .. . - ------...-•-•-•..-- .......Rock Size .-----...... .................. - Distance to nearest: Well ........................................Foundation _................... Prop. Line ...................... (o REPAIR/ADDITION(Prev. Sanitation Permit# __..... ..._-------_--_..-____.__.._.__ Date ..................................) G Septic Tank (Specify Requirements) ------- ------ ----- ................................. ..............................................._................. ti Disposal Field (Specify Requirements) ------ ------- --------- -------------------------- --------- ....... -•------------.........-•-----•............. ....... - - --- ---- - ----- --------- - ---------------------------------............... -----------.......................................Tr - --------------•---------- -------- ---•-•--- ----------------------------- ---- -----------------------••-•----- ----------••---.............._.......... (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 Son 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 ubject to orkman's Co ensation laws f California." Signed .-.. . ..�Vit' �„ ..vC 4 __ ..___ Owner BY --- ----- ---------------- --- - Title (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYDATE ?. 2 -� BUILDING PERMIT ISSUED ------------------------------ .. ----- . ---.-..DATE - .. ......._.... ......._ ADDITIONAL COMMENTS -- ---- - -- - -- - -.....- _- ...-.._..- ..... _--------------- ----------_---- ------------ ----- ----- -------•-----........... ----•--- - - ._..... ..--- -- -- - ----- -- - -------- ---..._. . - - - ---------- ---.._..- - - - Final Inspection by: . - - _.. _ . Date 31 EH 13 2Ja 1-6£3 Rev. 51 SAt J AOUIN '.00AL HEALTH DISTRICT 8�7h 3M