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FOR OFFICE USE: - APPLICATION FOR SANITATION PERMIT S •----- ---------------••---•- --.....-•--------- _, (Complete inTriplicatel Permit No. ..................... •-•-•---••-•_• ............................................ This Perm itExpires i Year From Date Issued Date Issued --/ -K... 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 O inonce No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ... J. ._..-� 40L---- G ............—1.1 --...----...CENSUS TRACT Owner's Name - Phoney .T. T..71';,.W. Address ._....__... j _ l.. ..._......... city . ... Contractor's Name " F ...-----.License #X-31- _y3� Phone ...... ...... ...•------- . . f Installation will serve: Residence}Apartment House] Commercial []Trailer Court 0 I . Motel ❑Other. ........... �� Number of living units:.... ....... Number of bedrooms Z�...Garbaa`ge;Grinder ............. Lot Size`..._.L........ ., Water Supply: Public System and name ..............................•......... i , k.....................::.......Private (� Character of soil to a depth of 3 feet: Sand I] Silt 0, Clayj] Peat 0 Sandy Laam fl Clay Loam =] Hardpan[] Adobe'❑ply ilt Mat al`............ If yes,rtype :............:..... I .• ---••i• (Plot plan, showing size of lot, location of system In relgtio 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 208 feet,} PACKAGE TREATMENT I_}SEPT(C,TANK 1.1 Size....................... .. liquid Depth r t0 Capacity = Type . Material. No. Compartments Distance to nearest- JWel) ' Foundation .. � Total `, . Prop. Line ............. •--•, LEACHING LINE No. of lines -_-......_. I ..__..... Length of each line Total` `J Length .......... ................. o D' ..... Type+Filter Material -_--.-. ---_ Depth Filter Materlal:`........................................... Distance to nearest: Well Foundation Property Line ----- ........................ SEEPAGE PIT, 3 1 } Depth _.........-„ ,-._- - Diameter ................ Number _>.__.•.--....... ....._._.. Rock Filled Yes ❑ No Q O Water Table DepthJ ....................... ...................Rock 5 ze . '- -��-- - Distance to nearest: Well Foundation Prop. Line ....--•-.....----- ...................... p REPAIR/ADDITION(Frau. Sanitation Permit# ............................................ Date .................................. Septic Tan (Specify Requirements) ....................... . ...... .... --•--•----- D sposal Fie#dj {Spec fy RegUujire ent�L�� .. 0.. --------••- ........_...... --- `---... ..._.. `':X. ... =�-r.. . ...............•.. - k ...: . ------------------------- (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 County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Hom* 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 to Workman's Compensation laws of California.” Signed .......... -_.........--- Owner By ............. �._...._ -----------....-----.----I...... Title ...._ r.. f o e than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY __....... 1 . .. . . . .............. ... DATE ..J. /a . ................ BUILDING PERMIT ISSUED .............................. DATE .. ..........-.......... ADDITIONAL COMMENTS ................... .................................. 4AN ..................... ............................................................... Jinal Inspection by: ...... ................� .............•.........----....--- .Date ......t!. _!.t S JOAQUIN LOCAL HEALTH DISTRICT r.,t.L 13 24L_.A�njx-.-. cAL