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rvx vrriLx use:/�:....... .3 J APPLICATION FOR SANITATION PERMIT lCompleh in Triplicate) Permit No. .7 ...:�-� ................•--..................................... Date blued ......................................................... This Permit Expires 1 Year From Dat*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 compliance with County Ordinance No. 549 and existing Rules and Regulationss JOB ApDRESS/lC>CA N . .f Q. .i'�. .. ............................................CENSUS TRACT ........................... Owner's Name ........ ...�. �....g�..................................... .Phone `t` '-S�:L ........ Address ....................... � fJ�, .. .. c. ....City ----.._.. .... ................................./ ... Contractor's Name .......................(__ ?t/-?. ....V.14 7.: .................License .... Phone . �.i?. �7.... Installation will serves Residence Apartment Nouse f] Commercial OTraller Court 0- Motel❑Other............................................ Number of living units:.._./.__.. Number of bedrooms ----ate'•-----Garbage Grinder .... ••- Lot Size ............................................ Water Supply: Public System and name .............. ..................................._......... ` t.: .......................Private ❑ Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Q Hardpan❑ Adobe 0 Fill Material ............If yes,type............... ............ .._... (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc.. must be placed on reverse side.) NEIN INSTALLATIONS (No septic tank or seepage pit permitted if public sewer is avails-Wo within 200 feet,) PACKAGE 'TREATMENT { } SEPTIC TANK ze.......,�...`.X..� ........................ Liquid Depth ....P5 !6..r........ Capacity` . ... Type .. ............... Material...................... No. Compartments .........; ... Distance to nearest: Well ..........Foundation ..... Prop. Line - LEACHING LINE [ ) No. of Lines ...................— Ungth of each line......... .... .. Total Length ........................ 'D' Box ------------ Type Filter Material ....................Depth Filter Material ._......................................... r Distance to nearest: Well ........................ Foundation ........................ Property Line ....................... SEEPAGE P T [ l Depth Diameter ................ Number .............................. Rock Filled Yes ❑ No Q Water Table Depth ................................................Rock-Size_------.....:............._... ---__. Prop. line Distance to nearest Wel! ----.------•----•.......................Foundation ....._........ ..._..__............. REPAIR/ADDITION(Prov. Sanitation Permit# .... Date .................. Septic Ta (Specify Recluirementa) ........ 4:r.�c_.... s... > ..�.............. .. Disposal Field ISpecify Requirements) .•....`... . ..:�.......:.................... ......................................................I.........................I........ .............. IDraw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will be don* In' accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin local Health District. Hanes 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 mariner as to become subject to Workman's Compensation laws of California" Signed ................ ..... ..... ;.......... --••---- ............. Owner By ............... --.-•--- xitle ....-. of other t 2'� ner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ........ .......... DATE .. ,_. .e .1..:... . BUILDINGPERMIT' ISSUED .....................: ----- ... ...----........------.......--- ------..DATE ........................................... ADDITIONAL COMMENTS ... .......................------............................ Finol.I................. ..... ............ '........ .. --•-----....... ....... .................... ..%. ..q.! .._... nspectson by: ......... ....... . .. .......... ............Date EH 13 2!t 1-6F3 5�I SAN J AQUIN LOCAL EALTH DISTRICT S/7L 3M -