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FOR OFFICE USE- APPLICATION FOR SANITATION PERMIT 4 IPermit No. .Z3......p../. ................................................6.... ;Complete in Triplicate) / 7 ................................... / -/ Date Issued .................... ......................................................... This Permit Expires 1 Year From Cate 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: JOB ADDRESS/LOC, �� ......... �� ... 16 � ... ........... ....•..........CENSUS TRACT .............I...... ..... F � - ......Phone�3.....�:L�l�.� Owner's Name ....._ Address ...................... .� ........ . ._taZ.�Z'd _ .. City _. ------ -.... ...-_._. ............................... ::...:._.License # 3.��... Phon' Ab-7&61.... Contractor's Name ._...._..-•-- --------- ---------- ...... Installation will serve: Residence C)LApartment House Commerclol []Trailer Court 0 Motel [3 Other -•-•- -..........••••._.....---••-......--- Number of living units:..__...._. Number of bedrooms ..,'6.....Garbage Grinder ....._. .... Lot Size ..��7�1r'G`c=. ---------••••••••• Water Supply: Public System and name ...........I............:......._^.......-•-------._._....... ------............ Private Character of soil to a depth of'3 feet:, Sand El Silt❑ Clay ❑ Peat C] Sandy Loam 0 Cloy Loam ❑ Hardpan ❑ Adobe' Fill Material ............ If yes,type .................__.__..... I L (Plot plan, showing size "of lot,1location of system in',relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: JNo septic tank.or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ } SEPTIC TANK[ ] Size...............................:................ Liquid Depth _................... ,.---_ Capacity Type ...:................ Material.--....._............. No. Compartments .... ................. �t � Distance to nearest: Well ..Foundation ..: Prop, Line ....:................. V LEACHING LINENo. of Lines .....'Length of each line..................... ... Total Length [ l 'D' Box .....-.-.-.- Type,FlIter.Materlal `....................Depth Filter Material ............................................. r,1 Distance to,nearest: Well :`�`...........•.-- Foundation ........................ Property Line ..___................... SEEPAGE PIT [ ] Depth .................... Dlameter-................ Number -................._,.------. Rock Filled Yes ❑ Na s Water Table Depth `� - 3 --":Rock-Size O ........:.......... ....._.... Distance to nearest: Well .:.....................................Foundation ........... ....... Prop. Line ............ ty t REPAIR/ADDITION(Prev. Sanitation Permit# ......-:=•F•- _ ...................Date ... .... .... ......... � Septic Tank (Specify Requirements) �....... ...........• -•---' ................. . a Disposal Field {Specify Requirements) ...... --•.. ....="`-.- - ' ..- - .- - - ... ............................................. .......... ... ......[�. . ._..•_--- ._ ............................ ......... ji A ------------------- ....................... ...__......._.......__..__........ s ............................................ . . .....•............_......_...._....._..._.. ._.._.........- . . (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. Horne 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 subjects to Workman's Compensation laws of California." > ` Signed ---------------------_-- - Owner 9 -----.-.. .. .....-...._. .__ �. Title BY • . . .............:........._----.----- _.............. .... .. _...._....... (If of r hon owner) ` , F9R EPARTMENT USE QNLY ............................. DATE .. . APPLICATION ACCEPTED BY ... . `. . ........ .. BUILDING PERMIT ISSUED .................................................. DATE ADDITIONALCOMMENTS ...................................................,�.......--•-•-....;....... :..... ........................:..................................................... .._.._...---•--. -:.......--------- .._........- ..........................1 ..........••--... ........................ E.. _ ......................... . g Final inspection by . ... rt�•........,..............Date . raj....-z/ s . . SAN JOAQUIN 'LO I HEALTH DISTRICT �� r= w 13 24 I.-AR izR... 172 3-M=--