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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 .�r�- Zy 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 wit Count ' Ordinance No. 549 and existing Rules and Regulations: d. _ CENSUS TRACT JOB ADDRESS/LO TION .. .L._ ..... ' »... t �.=L. �._......- ....... •-- -_:.. ..... •............... .....Phone .._._.......__.._.... ............. Owners Name ... --- .. ..... --•- .._.... ' Address ...czS.�_ ........................ .... City . ^t ............. .. . r Contractor's Name .License # .� �` .._ Phone ........................:..... Installation will serve: Residen a Apartment House(] Commercial ❑Troller Court ❑ Motel ❑Other ....... .................................... , ,� ,. Number of living units:........ Number of bedrooms ... ..-_Garbage Grinder --_- ------- Lot Size __x.____. '� -� z rj Water Supply: Public System and name ::.. : ............._-----_--._..----• -------------- -------.- .....-----•....... ..... Private to Character of soil to a depth of 3 feet: Sand ] Silt 0Clay El Peat❑ Sandy Loam Clay loam ❑ f. Hardpan ❑ Adobe C) Fill Material ..... If yes,type ....--_----__------.- (Plot plan, showing size of:lot, location of. system in relation 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,) r PACKAGE TREATMENT ( ] SEPTNKt� Size.51.! IK..l_ x -5.•. Liquid Depth Y .............. ••-- - w o. C m artCaacityAei Typeo Material.----- - ments P Distance to nest: WeIIl. .__.......Foundatio __.. _..... Prop. Line ./P� .. LEACHING LINE [[.]/ No. of Lines ....... __...__-- Lengtk% eackt line._....,- -...-.--•- - Total Length •----Z �. 'D' Box ..l'-------- Type Filter Material lI .....,a.Z,..•Depth Filter Material .......kl- ----••-_........... .. y Distance to ne r st: Wei ..��J�, ,�7--.:. Foundation ...1..�.-' - --- Property Line ...,-�� •.. Is n� jII/ ...... Rock Filled Yes No { �SEfG>w`PI7 [ ja Depth ._.. 4 ��._.. . -- . Number v�.. 1 Rock Size _..��.__ __ ❑ ... ... .: ......... Distance to nearest: Well ..._...�.� _.Foundation JD. Prop. Line _..�. _ __ ......- Water Table opt --� t` REPAIR/ADDITION(Prev. Sanitation Permit !` ............... Date --............._...........•. ...) . Septic Tank (Specify Requirements? ; ' ..... .................... Disposal Field (Specify Requirements) ............. ••--------......---------•--------------•------ -------- ........ ............................................... (Draw existing and required addition on reverse side) I hereby certify this application and that the work will be done in accordance with San Joaquin y that I have prepare County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local health District. Homeowner or lic6w 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 any person in such manner ' as to become sgbject to Workman's Compensation laws of California." SignedOwner B .• ... .�.. _ ... (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- -- :-- -- -:.........-•------------•••----- ...................................... DATE .... :--z :. . ................ " BUILDING PERMIT ISSUED ....................... DATE ..................-------.................. ADDITIONAL COMMENTS � .................................. es.... .... �.. ....... „ ._... • ...... ... Final Inspection b _-- ....................................................Date ..f ..... SAN JOAQUIN LOCAL HEALTH DISTRICT 7/723 .K c u 13 24,_-Aa o— qM