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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ..............L...... (Complete in Triplicate) Permit No. . .. ............ j .. ........ This Permit Expires 1 Year From Date Issued 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: .. x JOB ADDRESS/LOCATION ,.....:-. �?.. _-�-. ,• ,,,,,--• - CENSUS TRACT IM tet.- --� ...... <, 1 Owner's Na �C{/., ...y_ -.... .................................. =........ hone .................................... P Address ...... ....... . ..... ....... _...--. .... .:- " .... City Contractor's Nome ... (� � ------------------•- ..License # :....-...1._. Phone Installation will serve: Residence Apartment House 0 Commercial ❑Trailer Court Motel ❑Other Number of living units:.,------ Number of bedrooms` d'�Garbage .Grinder --- ...... Lot Size �.- Water Supplyr Public System and name .............• -❑ I ....:.....................--- ••-- ......-.. = Private Character of soil to a depth of 3 feet: Sand Silt❑ Clay (] " Peat[] Sandy Loam ❑ Gay Loam ❑ Hardpan Adobe -0 Fill Material ............ If yes, type ............................ II (Plot plan, shoeing size of lot, location ofsystem 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 [ ] SEPTIC TANK[ „ S#ze----------------------------------------- ---•-. Liquid Depth ............. Capacity Type Material.- Distance No. Compartments - •--............-- T e _---------_-- ......._ Distance to nearest: Well Foundation Prop. Line ----- -•---......... ....................... LEACHING LINE [ ] No. of Lines ....---�--------.. Length of each line----..:-----.t1--0 - Total Length _ ........ ......:.. 'D' Box Type Filter. Material ......Depth Filter Material ...................-.€•,r-. Distance to nearest: Well ...... •.... Foundation ....1.Q.............. Property line T ......... -SEEP, E-PIT, j Depth 3.4.10;_A/l Diameter .. Number .......... .............. Rock Filled Yes ❑,..._...Na•Q Water Table Depth .............Rock Size Distance to nearest: Well ------- -.�G� ,p..... ............Foundation .....1-.C?........ Prop. Line ..._�x ............ REPAIR/ADDITION(Prev. Sanitation Permit# ..................... ------------_------- Date .................................. Septic Tank (Specify Requirements) .............................. --------- -.....--• ................................... -----....... .......... Disposal Fiell (Specify Requirements) ...............................................•.-_................-........ ...._ --------------------- n, _(Draw existing and required addition on reverse side) 1 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 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 any person in such manner as to become subject to Workman's Compensation laws of California." p Signed ......: N By ........... ... �_...• ..1 1 . xitle .............r than owner) s r FOR DEPARTMENT USE ONLY APPLICATION kCEPTED BY.. T& .........BUILDNG PERMIT ISSUED, ..... :.-..M.....C...L ........-_.. DATE ........................................... -�•-d••..`...Z--•7--•_•..:7..................................ADDITIONAL COMMENTS ...................................................... --••-•...................••--........... -.. . ...........................� _.._......_.. ......-- •-----......--...._..�................................... .-------------------------------------------------------------- ...................................._ ....-...................................................... 3 Final Inspection by: --._ ............... ,[ ?'? Date ...1 -.- �.:..._�..- . .... ...--------••----- .....--•---•-----...... SAN JOAQUIN AOCAL HEALTH Di5 - w 13 24 ,-,AA Da„ KAA