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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: 4 {Complete in Triplicate] Permit 4 --------------- - This Permit Expires 1 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 compliance with CountyOrdinanceNo. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATIO .. �4►� - ' Owner's Nam ----------------------- CENSUS TRACT - -- ----- ------ -------- Addr ess.- Phone - Q�' �- -- -------- ------- y �. City _Zi �= P Contractor's Name___.____.__ — � ---- ----------------------- ----- ,y - -- •-- - ----- -=----- ------- --- --- --License #__�._�D..-��d._e�---Phone-'��/ Installation will serve: Residence ❑ Apartment House.❑ Commercial)< Trailer Court ❑ Motel ❑ Other------------------------ I Number of living units______________ Number of bedrooms____ Garbage Gr' der-_-____---__Lot Size_ ...................... Water Supply: Public System and name------ ----- - --- -------- ------- �------- ----------------------- -------- -- .---- -- ---- t - ------- - -- - ----- _Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe Fill Material_. ---------If Yes, tyke---- --------- -------- - (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,} PACKAGE TREATMENT [ ] SEPTIC TANK �-�W e- ��..S�X ------------------ ------- - ---Liquid Depth.-4 --- - a�� -Cw Capacity/ .------- TYPe-�------------- - --- .Mafierial ---------No. Compartments------ LEACHING LINE - ------- Distance to nearest: Well 211114211114-- - i - --- --._Foundation----s��______- --- p'Pro Line---- � ------- ---- � _ ,pCl No. of Lines------/----------------- Length of each line..--Z- -------------------.Total Length-------4Q--1---------------------- 'D' Box__----------Type Filter Material��_� &_ Depth Filter Material__-____ -- --.-___--__- Distance to nearest: Well= e - _---------------------------- - _ -__Foundation.__l0_0-- -------- Property Line_-- --------------------- SEEPAGE PIT D< Depth._02 $•- ---Diameter:73-----------Number---------/---------- ------- � JOle Rock Filled Yes, ` No Water Table Depth------- -, D-Q-- _-.----- _- w ----------- ---- ---Rack Size---��•3_-------- - Distance to nearest: Well _/ �- --_._ Foundation-_ _Q-'_ --.Prop. Line------------------------- REPAIR/ADDITION (Prev. Sanitation Permit#------------- _-------------------------------------bate-.------- -------------------------- Septic �.Tank (Specify Requirements)----------I-___________ - ° - -------------------- ---------------------- Disposal Field (Specify Requirements).--------- -------_--- _______ ----------------------- ------------ i---------------------- ---------------------- --------- ---------- --------------------- - -----------i--------------------- - -- raw 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 licensed 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 ub'ect to Workman's Compensation laws of California." Signed-�__._. -------------------- - - Owner BY .CQ � -- --- Title--------�-�4