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FOR OYFICE USE: j OU APPLICATION FOR SANITATION 'r T Permit No. - - i ........................ -.._...-__.._....., k _ f .� -------------- {Complete in Triplicate) 3-15.0...-------......_. G Dote Issued .�� ... This Permit Expires l Year From 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 County Ordinance No: 549 and existing Rules and Regulations: {- 7-.....__.. _.�... ..........................CENSUS TRACT ......._..._..........:..- JOB ADDRESS/IOCATI N .-.----.•-�1-��• Phone .................................... Owner's Name Address -. -- ..... � .1 U_ G.'.'-....... !. _.... r ..... ..._ C.ty �- �.e license Phone , Contractor's Name Installation will serve: Residence*Apartment House❑ Commercial ❑Trailer Court 0 Motel ❑Other ........ ................ ------------- / .. .Garba a Grinder lot Size ...�-...--........ ..... . •-•-----• Number of living units:.. -��__ Number of bedroo g Water Supply: Public System and name _.._ ............. ' C1c�'�� Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loori, {] Clay Loam Hardpan ❑ Adobe * Fill Material .......-...- If yes, type — _g {Plot plan, showing size of lot, location of system in relation to wells, buildings; etc. must be plated on reverse side:) �'x available within 204 feet,) V1 NEW INSTALLATION: INo septic tank or seepage rt ermrtted if public sewer�a � pp� P p PACKAGE TREATMENT [ SEPTIC TANK Size.- liquid Depth .... ....................5• Copacit Q-- �- Type Compartments ._ --•----••-•- Distance to nearest: Well Cel—&Ze -------Foundation --- .. - ...... Prop. Line _ -------m Length of each line . ....f-..: Total Length _ ��------ ---•--•• LEACHING LINT~ No. of Lines -�-�- Efo 'D' Box ..4 Type Filter Material _ ...Depth Filter Material ....................- ter.� �..._.. Number ..../._.....---._... Property Line ..� .............V, Distance to nearest: Wel ame�. - - -- I`aundatian �-� �'- .Rock Filled Yes � No ❑� SEEPAGE PIT Depth _ �i Rock Size Water Table Depth . --. ...�-----------------•-----..........-- � w _.�_t�.�..._... Prop. Line ---.�....----------- REPAIR/ADDITION ......... Distance to nearest: Well _. �'-`r`-�-•-........Foundation - REPAIR/ADDITION(Prev. Sanitation Permit# --------.-------- --- . ..........- --- Date ---------- ----------------------- Septic ---- --- ---Septic Tank ISpecify Requirements) ... . ..... ............................................... .. Disposal Field (Specify Requirements) --------------- - ........................ .......................... .......... _ ._.. ---------- -------------............................. - --- . ._....- . ---.. ..... ........ ------ ... .............................. ------------------------------ ....._ ----------.. ....-----...... ... .. l � � . (Drew existing and required addition on reverse side) 1 hereby certify that I have prepared this applicationand that the work will Wden*.in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin local Ngalth District. l♦ome owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shWI not employ any person in such manner as to become subject to Workman's Compensation laws of California." tL Signed .:.. .... ... . :-•--............ •- ----------• Owner By ------ Title ` Ilf other than o erl FOR DEW MENT USE ONLY ---ATE .. . .__...--- APPUCATION ACCEPTED BY ........ I -- ........- -.. ATE ... ._._.... --•--.-... BUILDING PERMIT ISSUED ....... .........�_-. ,.. ..,.__.... -_-.. _. ..--.----,.____._... - . ADDITIONAL .............• COMMENTS -.....-----i - ---------- ------------....- i -- ------- --- - -- .-. -.-.-.--- ------.-.-•..._.._........ - . . ........ ...... ............. ............... ---- _ - .........Date ..................... .. Final Inspection b SAN JOAQUIN LOCAL HEALTH DISTRICT 7/723t1i , .