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lip FOR OFFICE USES APPLICATION FOR SANITATION PERMIT ` ---•-..._. .•................................•........... Permit No. ....7..�.: 1. p (Complete In Triplicate) ........... .....�................................... .. - This DonnIt Expires 1 Year From a . D to Issued Apphcatlon is hereby made to the San Joaquin Lowy Health District for a permit to construd and install the work herein described. This application is made In compliance with County Ordinance No. 549 and existing Rules and Regulationse / NX!� ......`. p •.!...........................CENSUS TRACT ...........I....... f JOB ADbRESS/LOCATION .._......__ ... �� .�....... Owner's Name .........._��lJ / r�.........11 �................................... ... ............ �.....,. ,........Phone :..! -!.. Address . .........................City ......L-t!.'�C./..... ...........................---•............. . ... Contractor's Name .........................Ll.Cf117.i?il ............................................License # ........................ Phone ......................... installation will servo< Residence AApartment House❑ Commercial❑Trailer Court ❑ � Motel❑Other............................................. Number of living units,........... Number of bedrooms ............Garbage Grinder ............ Lot Sire � -----•.... Water Supply: Public System and name ..........................._ _...................._.......�..................... ................PrhratsA I Character of soil to a depth of 3 feats Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam day Loom ❑ F Hardpan❑ Adobe 0 Fill Material ............if yes,type............... ............ Wot 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,) PACKAGE TREATMENT E ] SEPTIC TANK t I Size............................................ . Liquid Depth ... . -.............••••• r Capacity .................... Type .................... material...................... .....No...Compartments ...------•.._...... Distance to nearest: Well .Foundation Prop. Line ..� tEACHING LINE } No. of Lines ........................ Length of each line............................ Total Length ....... ........ :....oc 'D` Box ............ Type Filter Material ....................Depth Filter Material .......................................1.......O Distance to nearest: Well ........................ Foundation ........................ Property Line ... .................n' SEEPAGE PIT O Depth ................ Diameter ................ Number ............................ Rock Filled Yes ❑ No,0 Water Table Depth _.............................................Rock Size ................................. t fi Distance to nearest: Well ........................................Foundation ....... . ........ Prop. Liras REPAIR/ADDITION Wrev. Sanitation Permit# ............................................ Date ................................ _) I >. Septic Tank (Specify Requirements) ................ ........... • .... ---- ...... O ~ . . . Disposal Field (Specify Requirements) ... ••• t ••• -. .. ............................ ......................................................................................................... .......--• •-•-.... ......... ....... . ................................. : ........... (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 Ilcen- %ed 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 becom ct to Workman' Compensation laws of California. Signecd .................................................6...... Owner . it1e S ................ By ..... ........... ..... ............................................................... ............................... ! (If other than ownad l FOR DEPARTMENT USE ONLY APPLICATION -ACCEPTED BY ........ _. .i. �LC�d�........................ .... DATE ......:7 .f...�.. BUILDtNG 'PERMIT ISSUED .................................`..................:..::................................................DATE--................:... s. -.--- ADDITIONAL COMMENTS .... . ......... ............ ............................ ............ .... .........................r....• -. ..---• .... ........ ....... ... . ............ ...........Date .............: FinalIns ection •-•................................. E Eli 13 2)e 1-60 Roy►• 59 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7)t 3M