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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ..................... .....-.-..-..........._I.....-. Permit No. ,3.�.� - (Complete in Triplicate) ............................I...." ' Date Issued ......../,5�:..... This Permit Expires ] Year From Date Issued 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. . . .CENSUS TRACT ....•..... .. JOB ADDRESS/LOCATION � �-•p--..-. �..-.._....... ...... ... . . - Owner's Name �f- ---• -----... Phone ...................................... s I � :.....i..... AddressCl r - m...... ........................ Phone Contractor's Name �3F . ' Installation will serve: Residence Apartment Horse'[] Commercial❑Trailer Court .(341 I ' Motel-❑Other ....-•--••.................... �. .i. . 1 - r, Number of living units ....... Number of, bedrooms ..,../.-.-.Garbage Grinder .._..- ..... Lot:Sire. ........:................•--=-•.-•-•--•_--. Water Supply: Public System and name ..... : .. ----•----..-. ------............................... } Private to Peat 'Sand Loam. Clay Loam Character of soll to a depth of 3 feet: Sand❑��.Silt❑ Clay ❑ ❑ Y ❑ - y ❑ Hardpan Adobe '❑ , Fill Material -.:.�........ If yes;type_.. ------------ (Plot plan, showing size of lot, location.of, system in relation.to vaells, buildings,.etc....:must .14 placed.on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is avalloble,.*thin 200 feet,) ! SEPTIC TANK Size ................... ---- •.... -- Liquid Depth .........•--...........-•-- PACKAGE TREATMENT [ ] I J ,., ,. .• Capacity Type •` at `..-'�-----..... .No. Compartments ..............;... Distance to nearest: Well _ -.-Foundation Prop. Line ••. .. Total-Length ..... LEACHING LINE No. of Lines Length of each line..........: ......... .n� a .� 'D' Box __# Type�Filter``Material .:.:.:--:._Dep ter Material' -:........................... . . .-< Property perty Line Distance to nearest: Well - ..._ Foundation � •••-••-- SEEPAGE PIT [ :. Depth :............. ..•• •--••• Filled Y o ..........:.:....... Diameter ------•-------...Number .: - oc ❑.. Water,Table. Depth...----------•--- •------ ...............` .Rock Size ..................... k es .... . ,� Foundation 4 Distance to nearest: Well ---=---••---•.--•---•-••----....: . I •...... Prop. ---=---• �- Line'.---..�. } REPAIR/ADDITION Prev. Sanitation Permit# , .... .. . ..--•--•-- Date .-•------ . ...._..--••--..• . -y : .................. 3 ....... ........................ Septic Tank (Specify Requirements) .° ..................-y..Y..._-------............................... ------ Disposal Field (SpecifyRequirements) ..................... -....; -..... ...................... J ............................... _ . z .......................�. (Draw existing and required ad ition on reverse si e) ..,,. 0- ' 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.'Home owner or liven. 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." � . Owner ................ ................... .. ........ ..... .'.:.... 1. . Title ... (If other than owner) FOR DEPARTMENT USE ONLY - ...... ...-•-- -....... DATE . APPLICATION ACCEPTED BY . .. . _ BUILDING PERMIT ISSUED ,.....-.--_DATE . --- ADDITIONAL COMMENTS .......: .. ..... ....•••• ................................... • --•-- -- - .F....'w:' ............................. .. ........................................---. ............................... ................................. .:..... z.. a_ ----. __ •-------- ........._.._ ---• ..:....-- i :_Date` _ .. Final inspection by: ' ' •.................................. ............... .-.... SAN JOAQUIN LOCAL,HEALTH DISTRICT �, 7.3 24 7/7232%1