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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. .................................................. (Complete in Triplicate) ................... . This Permit Expires 'I Year From Date Issued Date issued .7._:.......... ..................................••--.......-.._.-:.... 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 mode:in compliance with County Ordinance'Nol 549 and existing Rules and Regulations: l JOB ADDRESS/LOCATION � CENSUS TRACT ho Owner's Name .�,� _ ............ .............. .. ........ _P ,71 . - .. Address -- Q .. :, -......._._ .................. City -...-. ._. �� ,. ��- ------•-•--�-=------•p'-=License#•�d��.=.�--/-=---• �'.. Contractor's Name -C. _.- f <r� _. .. Installation will serve: Residence ❑Apartment House C] Commercial []Trailer Court- [� { n Motel [3 Other _.." Number ofliving units:............ Number of.bedrooms ___.......Garbage-Grinder ...`..'......... Lot Size ..................... a r Water Supply: Public System and,name -_----_-------------"------7----- ----== - Private Peat Sand Loam Clay Loam 0 Character of soil to a depth of 3 feet: Sand 0 Silt E ` Clay [] Y Hardpan [] Adobe'❑ Fill Material ....-.-.--.- If yes,type (Plot .plan, showing size of lot, location .cif, in relation,.to.wells„buildings, etc. must be.,placed on reverse side.) ` d if public sewer is available within 200 feet,I. NEW INSTALLATION: c (No septic tank or_seepage pit per Sae;_ Liquid Depth .......................... � b i1 PACKAGE TREATMENT,j[ ] -SEPTIC TANK t ] �r r �. .. r ..... 'Capacity ........ Material....-------•••------- No. Compartments _. i Distance to nearest- Well Foundation. Prop. .---...----- a e 2 r i . No. of Lines --- ........ Length of:each line.------------:..>=•--•_. Tata) length ............................ LEACHINGI`INE [ ] ------�-----• D' Box Type Filter Materidi-±i'..............Depth Filter Material ............:. m Distance to nearest: Well ._____••. •-•- --=-• Foundation .---.....------------=--F,. r6perty Line ...__... ............ SEEPAGE PIT [ Depth :-...-•-•.. Diameter Number :-..._........ Rock Filled Yes No ❑�� - ' Water Table Depth” ...:. ......... Rock Size Distance to nearest: Well ..<..........-•••--.....• Foundation -------------------- Prop. Line .. REPAIR/ADDITION Prev. Sanitation Permit�# -� •-•---•-•...... Date r::.:::,.. � t - ............. Septic Tank (Specify Requirements) ....................... __-R-------"-•-------- -_-----_-_-..--------- ...... ............................ 04W r, �L Disposal Fiel ------------- d {S ecify Requirements) __.��-_'..�� '�--•� �'• --�--� � ' .. ----- ..:.............................. ...._.. ............. ..............••................. (Draw existing and required addition an reverse side) I hereby certify that 1 have prepared this application and that the work will be done in accorddance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the SanJoaquin 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, 1 shall not employ r any person in such manner as to becWsubjecto Workman's Compensationlaws of California."= = = -- -•.. Owner Signed ... ..... ,,//�� !_.- .J itis :L1f A—&' CYr than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- ..................................... DATE ..J�_ • BUILDING PERMIT ISSUED ..................•........_. ............ ..DAT :_.. :'._......... = - ADDITIONALCOMMENTS ..---••................................. .:----,.--..-_---.._.....-- ........................----•-•-- = ............. .... .. ...., ......... ....................:.... ....... ....................... . . ....... --- Final Inspection by: --••- ..................... Date .:. _. ..... SAN JOAQUIN LOCAL` HEALTH DISTRICT 7/723 M