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FOR OFFICE USE.- 3 ............... = APPLICATION FOR SANITATION PERMIT ..-----•......................_ ..................... ..... (Complete In Triplicate! Permit No. ...S= y'S 3 Date Issued �`1 This Permit Expires 1 Year front bate " 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 Regulatlons: JOB ADDRESS/LOCATION .._..�.00�._v:�.I ........ F. , .._ .... ................... ....CENSUS TRACT Owner's Name ....... ......................................Phone .................................... Address -------------- .. ._. u:z,� - ..Cats Contractor's Name ---.•--_ ----7 . license ._ .. ~�� Phone . /.. � Installation will serve: Residence[Apartment House Commercial❑Frailer Court �] Motel ❑Other........................ Number of living units:------ Number of bedrooms Garbage Grinder Lot Size _..l Water Supply: Public System and name .._---- .._._ ........ ................................�...................... Character of soil to a depth of 3 feet: Sand❑ Slit❑ . Clay ❑ Peat❑ Sandy Loam Clay Loam Hardpan[] Adobe ] Fill Material .....----..:if yes,hype (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse aide.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT �t { j ] SEPTIC TANK ] Size �4.d._ ........... Liquid Depth ._-- . CapacitY'.1-AP0-- Type •-_- - Iq ?'�..._ Material---------------------- No. Compartments . i Distance!to nearest: Well •--••-• Foundation ..._... ......._-- Prop. Line. LEACHING LINE [ ] No. of Lines Length of each lino-----.... Tota! Length . .---- .............. .._ •'Tlf 'D' Box .�_ ..... Type Filter Material .Depth .Filter Material Distance {to nearest: Well ---------_------------- Foundation _...................:.... Property Line ............._........_. SEEPAGE PIT [ ) Depth 4 � X X.fd Diameter �...�_ --• ----_---- Number .:.... ............Rock ❑ ❑, Water Table Depth _...........:........ _-Rock Size Rack Filled Yes No Distance to nearest: Well .............. Foundation Prop. Line REPAIR ADDITION(Prev. Sanitation Permit Date --------------•---- -•-) I Septic Tank (Specify Requirements)._ I _........... ----- Dispasal Field (Specify Requirements) ______________ ----- •••- l .................. ---- -• :--•----------------•-------------- E -------------------- -. -- •--•----------••--- ------------._._.... . . .........................•---•--.-.------.-__----••-..._-.-----..-.-._.-._-----.------ r (Draw existing and required addition on reverse side) ' 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin J County Ordinances, State Laws, o6d Rules and Regulations of the San Joaquin Local Health:District. Home owner or 1 cert- 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 manner s as .to become subject to Workman's Compensation taws of California." Signed ..-- ' -- Owner By ---------•- Title -----.--............. --- -- -- ----------•- (If other than owner]� . .......... ........................... 1 OR DEPARTME VSE ONLY " APPLICATION ACCEPTED BY -- -.- BUILDING PERMIT ISSUED ._.------.--•`-----------. _ --- _._ ---... DAT! ..............�_ .... .., .` "" w _= ----=--DATE ADDITIONAL COMMENTS ------ - -•.-•-. -- .--•..................................... , ------- - Final Inspection by.. _ .•..... -- :............ Date `� Eli 13 21 1-,•6 f3 SAN. i SJOAQUIN LOCAL HEALTH`DISTRICT $/7]1 3