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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ...................................".......... Permit No. �.....`:�� (Complete in Triplicate) ....-•------_----. ............. 6: � ..... This Permit Expires 1 Year from Data Issued Date Issved/��:� 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 complionc with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .._. Qr........... . ........CENSUS TRACT Owner's Nome_- � �'. .......L,.. u.::_.. : ......�..... .Phone -.r��: Address ........::....• ••. -- .f/97 ........... .. . ......... ....._..... City `Q ` ----- ............. ......................... Contractor's Name -------- --- .�._ [ . ��:ISS:::._ 0^!"4'--- " __License # -:- ..::.: Phone 6 �aP _ a Installation will serve: Residence 14-Apartment House fl Commercial OTrailer Court' 0 I Number of living units:.....,..--. Number of bedrooms _.�•-•__Garbo e Grin ter..:......' Motel, . Other ...... .............:.. .............•. ..... r ' g . - - 9 :. ..Lot a ... .. .... .. ... ............. Water Supply: Public System and name ... ........... �. i_........•...:.-•-•.•----...............:._Private l] i Character of soil to a depth of 3 feet: Sand 0 . Silt O, Clay;C] ' .Peat 0 Sandy Loom :C) Clay Loom 1 0 Hardpan O- Adobe [] Fill Material ...:.----- If yes,;type ............................ r ° (Plot plan; showing size of .lot, .location, of, system:,in relation to wells; buildings, etc...must. be. placed on 'reverse. side.) k NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer1s available within 200 feet,) PACKAGE TREATMENT. C [ ) '-•-•-......• ..._....-.-...:Liquid Depth .--•- •----•..... . SEPTIC TANK Size- '- -. -- - Capacity .................... Type`.._._. .........._... Material..........._ __ No., Compartments . .:_.... ........... Distance to nearest: Well -........Foundation: :...... NO. Line LEACHING LINE [ ) No. of Lines ......... ......::�_.._ Length' of each lirie.-- .__.:..... ...... ... Total; Length ................_...._..,._y i k.._......1 Type Filter'Material '-Depth ;Filter Materia) .... :. :..---. L1' Ox ... .. . ..._. Distance to'nearest: Well .... Foundation ........................ Property Lire k SEEPAGE PIT Depth Diameter Number ;Rock Filled Yea No Water Table Depth. : ' -•- -• -• -_ ._. : ... ,_ .. .Rock Size -------- . -- -- Distance to nearest-Well .Foundation r .---�--•.................:.....:....... _..----...-- ...... Prop. Eine .................... --- REPAIR/ADDITION(Prev. Sanitation Permit Y#` ......... Date .....:................. . -Septic Tank (Specify'Requirements) ........ __ 4----_ __ _ �----- ---- -- -------- --- Dis sal Field (Specify Requirerr+en s) .._.__. . . -- - `�cr""f A.. . f�^------ .. °Q - --------- - ?�.Z: ---------------------------------------------- -------........................................... - ...- :(Draw existing and required addition on reverse side) {{ i 1 hereby certify that I have prepared this application and thatithe.work will be done'in accordance with San Joaquln County Ordinances; State Laws, and Rules and Regulations'of the"San Joaquiri1bcal 'Health :Dlslrict. Homeowner or Ilcew! sed agents signature certifies the-following:..: . . .. :. I certify that in the erformance of. the-work for which this erriiit is issued,,) shall not employ any person in ` °' such manner; { as to become su ' t to Work an's;Compensation laws of Californla." Signed ............. ... By .....-• •.. - ..::.::...:.:.....::.... ............. i itle . .....I-•-• llf other t n owner) FOR DEPARTM NT USE ONLY APPLICATION ACCEPTED BY - . :. ......:. DATE _ . .,. .'� :- • ---•--.. BUILDING PERMIT ISSUED .... ....................' DATE• ----..•.......... ADDITIONAL COMMENTS ...............: " ........ .i .. . ....................................... .... ...........:. ........ .. --- ....... Final Inspection by: ...... . .. :.... , .Rate / `' SAN JOAQUIN 'LOCAL HEALTH` DISTRICT =