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FOR OFFICE USES,.----------- PPLICATION FOR SANITATION PERMIT y(Complete in Triplicate) rm - Pe it Nom/~. . .... I _._..__.............:.............:..............._ .....11 This Permit Expires 1 Year From Dah issued Dote Issued Application is hereby made to the San Joaquin Local Health District fora permit to construct and Install the work herein describeel--thic application is��ii+.nde ;n co np 'a ce with County Ordinance No. 549 nd existing Rule: and Regufatlonsr JOIT'A515-Rf5//I.00AT1ONi.Il/ ( �.-- - . .. . ... ..,.......CENSUS TRACT .......................... Owner's Name ........ Address f -----..... ... . hone ......... .................�...._._. ' may. °7 .. .' .-....._. . r ..... City ._. ........ ~...., '' �� :.,............._.._................. ... i 1 , !!U, Contractor's Name •`9e ��.... .. ,.:...........license Phone . . ........................... Installation will nerve: Residence p'Apartment House Commercial QTrailer Court ❑ Y ; Motel ❑Other................:........................... Number of living units:....... Number of bedrooms .Garbage Grinder Lot Size Water Supply: Public System and name ..........:.... ..Private L! Character of soil to a depth of 3 feet: Sand tj Sift❑ Clay ❑ Peat d Sandy Loam 0 Clay Loam ❑ Hardpan Q Adobe ❑ Fill Materlol ............ If yes,type............... ............ � i !Plot plan, showing size of 'lot, location of system in relation to wells, buildings, etc. must be placed on reverse side,) U NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TAMC �2 ' �/ .Y.5` { 5ize.. ... . ............................. Liquid Depth .-�................ Capacity -Iia...___.. Type �� Material___, . No. Compartments I Distance to nearest: Well - .5J .............Foundation ......L ... Prop. Line ..- �... ..'.� LEACHING LINE [ No, of Lines ...__.-, _____"- f Length of each tine..---- 4. .....--.... Total Length -Z'� , ....... 'D' Box _...t' Type Filter Material .......__ P._---.Depth Filter Material .......L 1 .............................. Foundation i)Line - - _- Distance to nearest: Well .....�:�- ..._..1:�. Pro e S i Y 11 SEEPAGE PIT { ) Depth -____.._"___- --- Diameter Number ............... 1 .......... Rock Filled Yes ❑ No Water Table Depth Rock Size ` Distance to nearest: Well -------------------------_-.----.-----Foundation _ Prop. Line ...... O REPAIR/ADDITION(Prev. Sanitation Permit _--__..__ Date Septic Tank (Specify Requirements) ..............•------•--•---... _ ..--• •--..--..------.........--- .:_........... ................... ............: .. Disposal Field (Specify Requirements) .......................--.................. 1 .-_..._....................... ---------•----- ----- "---. �P (Draw existing required .................... I equired 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.District. Hems owner or licen- sed agents signature certifies the following: , "I certify that in the performance-of the work for"which thisermit is Issued 1 shall not i P employ p y an y person in such manner as to become subject to Workman's Compensation laws of California." Signed - �_ ------------- Owner BY --- a_-c L _ ------ title --- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .........OV_-••- BUILDING PERMIT ISSUED __` _ --_ ----------- ----------••----------..._...------- _..... DATE ....,..-- ..... ADDITIONAL COMM TS _. _.._..� .:..f r _ " .� -e�.�l�C�,.r� .r.�... . _ ---------•---------- i incl Inspection by: ..--- -•--- —/5 ........... ........Date ... ----.....--EH •- --• •--...._.........---- 13 2 -6 mow• SAN JOAQUIN .LOCAL HEALTH DISTRICT 8/7]! 3M 1