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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT _ -.........._ 1- No. (Complete in Triplicate) Permit ......- ........... ............................................. . This Permit Expires 1 Year from Date Issued �• . hate Issued 3.::.............76 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 mode in compliance with County Ordinance No. 549 and existing Rules and Regulations: // JOB ADDRESS/LOCATION .f...�_.."s!5-. -.-.._.•C.��`. ... .. .:.. . ..�. .�..._-......... ......................CENSUS TRACT ....•..•.................. Owner's Name . ...._.' ,�(/ - !fCt? _ . . . �... ......... ........................:.:..............Phone ......,.. ,.,.., Addressam ...�.... .. . .............................City -.... .............. ....,.....------.. ...... Contractor's Name .... - . ..... -. ....... ..:.License i4�-` Z:Ui .�.... Phone J Installation will serve: Residence'M Apartment House Commercial ❑Trailer Court 0 ' Motel ❑Other ............................................ ` Number of living units------------- Number of bedrooms Garbage Grinder . Lot Size ... . Water Supply: Public System and name -----------. ..Private ❑ Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan 0 Adobe ❑ Fill Materiol ............ 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,) PACKAGE TREATMENT ( I SEPTIC TANK T I Size.................................-......-------- Liquid Depth .......................... . Capacity ---------------±---- Type -------------------. Material...................... No. Compartments ...--•................ Distance.to nearest: Well ....................................Foundation ...................... Prop. Line LEACHING LINE { J No. of Lines ...�:....._._ .. .. A - - •-- Length of each line--------- Total Length .................. 'D' Box ------------ Type Filter Material ....................Depth .Filter Material ........................................ i Distance to nearest: Weil ------------------------ Foundation ---............. Property Line ........................ SEEPAGE PITDe[ ) p#h qX-TZ�? - Diameter --------------- _ Number ......I................ Rock Filled Yes,[ - No C3Water Table Depth :..--•--•.......................................Rock Size ................................ Distance to nearest: Well ----------------------------------------Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ...........----------------------........... Date ................_..................) Septic Tank (Specify Requirements) --- ------•---•---•---------------•............................................... .............................................-----,.:.. Disposal Field (Specify Req.uirementsl --------------------- ..__........---,---__---........•-__-........ ..• -----------------------------------------•-----------------------------------_--.------...-...-..._...._.. ............................................•................-....... .......... -•-•--• - --------------------- ---- -- ------ -•-------•-------------•--•---------- -------------------------- ---------=------- ..........•.............. ...... {Draw existing and required addition on reverse side) 1 hereby certify that 1 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 licew 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 subject to Workman's Compensation laws of California." Signed ----------- Owner BY .-... ---- Title '"3' ...----•-...... (If other the owner) _ FOR DEPARTMENT USE ONLY f APPLICATION ACCEPTED BY -. - { e rte,--------------- -- -- ..DATE .: BUILDING PERMIT .ISSUED ---- -•-------- ---------- ------------DATE -. ._ ............ .... ADDITIONALCOMMENTS ---•------ ---••- - ------------------ ---•--------------------------•-- ------------ ---.-....-.-..........................................,.._.._..-....... --e -------------------------------- .. -- _ ...._--- --_ ----- --.. --------- -- - - ------ Finol Inspection by: Date .. .-- EH 13 2h 1-6 lfev. N JOAQU LOCAL H€ALTH DISTRICT f1l 3M("; `YJ k� f