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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .......... lComplete In Triplicatel Permit No. ............. ....... .••••.......- -- This Permltf:xplres,3 YsarFrom Dotelssued Date Issued ./J ........ 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: JOS ADDRESS/LOCATION . .--._-Q.c�. - ...CENSUS TRACT /Qe4�ito Owner's Name aw-A _ _ . .T .................. ................................................. .. One Address .. T. . . � ( -. " '► ........ .. .. city ...' .. a:c+¢ r , ........... Contractor's Name ................................License #�? J �._... Phone Installation will serve: Residence M-Ap-ortment House 0 Commercial ❑Trailer Court 0 Motel ❑Other ............................................ Number of living units:............ Number of bedrooms .......Garbage Grinder ...4k. Lot Slze .......Q,1.................. Water Supply: Public System and name .............. .....Private ..... _ - ........ (\ Character of soil to a depth of a feet: Sand❑ Slit❑ Clay 0 Peat❑ Sandy Loam U�--Clay Loam ❑ �f Hardpan❑ Adobe-0 Fill Moterfol ... ...... If yes,type............... ............ (Piot 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,) n PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size................................................ Liquid Depth w .......... .......................... Capacity -----------------_- Type ------------ -- Material...................... No. Compartments Distance to nearest: Well ------------------------- -- Foundation .... .................. Prop. Line ...................... LEACHING LINE [ ] No. of Lines ..............•--------- length of each line.....:...................... Total Length 'D' Sox ............ Type Filter Material .....................Depth Filter Material .............. Distance to nearest: Well ........7.........�. Foundation ................... .... Property Line .................... SEEPAGE PIT.. [ 1 Depth --------------- ---- Diameter ---........-% Number ..----•--...._...... ._._... Rock Filled Yea ❑ No ---.� Water Table Depth _-------------------------- ................Rock Size ------....... .................. Distance to nearest: Well ----------------------------------------Foundation .................... Prop. Line REPAIR/ADDITION}Prev. Sanitation Permit alt` ........ . ................................. Date .................................. Septic Tank (Specify Requirements) ---------------•------------•-•-----------__--•......................... Disposal Field (Specify Requirements) -----[ - 4 r . .... ............ -- - - -- - _...__ .... , (Draw existing and required.addition on reverse ---.......................... ........................: .."'side) I hereby certify that t 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 for which this permit is Issued, I shall not employ any person in such manner as to become subject Workman's Compensation laws of California." Signed ------------••- -_. Owner ---------••------------------------------••--- - _....-- Sy ---....._ . 3itle _LJz "" f other than owner) O DEPARTMENT USE ONLY APPLICATION ACCEPTED BY F --------- DATE BUILDING PERMIT ISSUED --- --•- ---------- --------_--DATE .......................... ADDITIONAL COMMENTS ................... ---•-.•-------- -------------------------- Final Ins ection b P y: ... -- z .,............. Date _.j'� -�cr.:� 13 2h -6fZRev. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7& 3M