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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. .-�:��(....• j....................................................... {Complete in Triplicate) .......................................................... �/ Date Issued ../...:........... I This Permit Expires 1 .._ Year From Data issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: '?. ...e. . - .... .. ...(� r�__L� _.._....._._CEN5US TRACT ............. . JOB ADDRESS/LOCATIO _ i s... `.... - -�. .............. --- -- Phone .................................... I Owners Name /., .5' -®�_ _. :...: :Litt' . . ...... . Address ._... --------... Contractor's Name... �` �----F.�.:..-----. icense # - Phone .. Installation will serve: Residence C'3 Apartment Hou, Commercial Troller Court I Motel ❑Other ..�_�'•�"`@. -•••• kNumber of living units ..... Number of bedrooms ....Garbage Grinder ............ Lot.Size ...0=1.............. ...... ........ I Water Supply: Public System and name ............................. ..............Private L� Character of soil to a depth of 3 feet: Sand❑ .Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ Hardpan ❑ Adobe❑ Fill Materiol _............ 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 septictankor seepage pit permitted if public sewer is available within 200 feet,) I PACKAGE TREATMENT ( ] SEPTIC TANK I ] Size----------------------------------------------.. Liquid Depth ......................... . No. Compartments ._......... Capacity ..... Material..................... .........•_ Distance to nearest: Well ------._Fovnclo lon ...................... Prop. Line ...................... No. of Lines ---------- ---•-- Length of each line.------..................... Total Length ............................ LEACHING LINE [ ] ,_ "� �� 'D' Box Type Filter Material ....Depth Filter Materia Distance to nearest: Well ...... ......... Foundation ....................... Property Property Line ...... ....... SEEPAGE PIT [ ] Depth ....:---------...... Diameter .......... Number Number ....._...__................. Rock Filled Yes ❑ No 0 Water Table Depth --•-•-•••. •---......---Rock Size ....--_----•--_- ............ I Distance to nearest: Well .....Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ......................... Date ..................................) Septic Tank (Specify Requirements) ----•--•-•-----------•---------•-- ------•-•••••---••--..--.....4...........:........... ...... ••----•-•--._._................... Disposal Field {Specify Requirements) - __ ......I.............. 1� �` �- --•--------- ........................................:......._.--------•....--------._......._-----------._....-------------•......_......._....._......_. (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 San Joaquin local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work far which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ................. ........ . .... ......... .....-- Owner By ............. ......... _ 4—_ Title ! . jlf other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ......... ............................................. DATE ...1-2 . .......... BUILDING PERMIT ISSUED DATE -_---------------------............ ...• .............. ADDITIONAL COMMENTS ' ...................................................................•--......-•............--......................... ._.........'.-:...: .-•-- -----. ......•-------1-.......•--- _-....-----....... ................................ ,�¢ C... .. ................... :.. - . ...... Final Inspection by: ..............................Date . -� ..� .. ........- ..............•--- ..... I SAN JOAQUIN LOCAL HEALTH DISTRICT c u 13 241_,An v.., rAA 7/723 M 4