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FOR OFFICI: USE: F.I.C..1.. APPLICATION FOR SANITATION PERMIT {Complete In Triplicate) Permit No. ..................... ----------..:._.......................................... This Permit Expires 1 Year From date Issued Date issued .!'a�'...:___... 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: JOB ADDRESS/LOCATION: . ..._ _. `}'�)� �C`/... -( ..........................CENSUS TRACT ..............-........... Owner's Name ... ._.6. �u % r� ---------........................... ...............P#�one ................................. — 4.t. 2 .... City .. ..... Contractor's Name ....... =r# Phone .............................. Installation will serve: Residence❑ partment Ho sed] omm ial QTrailer Court Motel Q Other _--:=Jul.-._- Number of living units-------------- Number of bedrooms ............Garbage Grinder ............ Lot Size ........ .. - Water Supply: Public System and name _____________ ....................................... ----- ----------•--......�.------------ ..Private Character of sail to,a depth of 3 feet: Sand Silt❑ Cla ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ I Hardpan E] Adobe Ill Material ............ If �type a ............... ............ Y (Plot plan, showing size of lot, location of system"in rotation 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,) PACKAGE TREATMENT [ SEPTIC TANK I ] Size................................................ Liquid Depth ----.. ................... Capacity -------------------- Type ------------------.. Material---------------------- No. Compartments ...................... Distance to nearest: Well ------------------------------------Foundation ...................... Prop. Line ...................... LEACHING LINE [ ) No. of Lines ------------------------ Length of each line..................---------- Total Length .................--......... m 'D' Box ......:__... Type Filter Material _...................Depth Filter Material .................................. ' Distance to nearest: Well ........................ Foundation ...................---.. Property Line ... ......-=---...... kSEEPAGE PIT ( ] Depth ........-- --------- Diameter ---------------- Number .............:... .......... Rock Filled Yes ❑ No 0 Water Table Depth --.--.--Rock Size .................. Distance to nearest: Well _____•..................................Foundation ....................... Prop. Line .................. P REPAIR/ADDITION(Prev. Sanitation Permit# ............. ............................ Date ................................... Septic Tank (Specify Requirements) ------ .................. / .....--------•-•- Disposal Feld {Spec' Requi ts) .. - .... . ...�Q`- _......... .1-------0 ........16�- -------- /. Z ------------------------------------------------- • --•-----------------------------------------•--------•- ----------------*•--------- ---------------------....._............................ IDraw 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.IDistrict. Horne owner or licen- sed agents signature certifios 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 Com sation laws of California." r Signed -------------------------- -'---•--•-------- Owner �. By Title ` d.�L� (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ ,=- _ ----- DATE 1.:..Z? BUILDING PERMIT ISSUED----------------------- 9_7 -------- --------------------------------------- ---------------------------DATE ADDITIONALCOMMENTS ............ ......... --------------- .............. -------------•--..........................---.---............................... -------------------- ------- ------- ........ - - ---•--•-••-------------- ......................------•...................... ............................ ._............. . ........................ .............._.....-............................... ........ ,!. Date . ...�...Z..f Final Inspection by: -------- . ..------•----------•----- .. . EH 13 .24 1-68 16sv. 5I AN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M