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FOO OFFICE USE. APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. ............. This Permit Expires f Year FromDate Issued Date Issued ..l-_............. 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: JOB ADDRESS/LOCATION ._..--..1 /. .... 1t rte.--, ,� �r1/.._...CENSUS TRACT .......................... Owner's Name ........ Y..t y cx.... -----------------------------... . _...---Phone ........................1- ••--•-•.. Address .....1.7. 41� .. c_.-.. .._. . . --- ---------------_ ------------ city .� - - -------------. .........................................:.... Contractor's Name ..._P .1.L.... -sP.ia ------------License # ........................ Phone ._......._..._... ............ Installation will serve: Residence 04-Ap"ortment House❑ Commercial ❑Trailer Court Motel ❑ Other ----------------------- Number of living units:........... Number of bedrooms ------------Garbage Grinder ...._....... Lot Size A4W ................. Water Supply: blic System and name . -------- - -------------_------------Private� \� Chor'acter of soil to a depth of 3 feet: Sand Sift❑ Clay ❑ Peat[3 Sandy Loam Clay loam �1 p ❑ ❑ Fill Mate rial ...... ..... If yes,type .......................... Hard an Adobe (Plot plan, showing size of lot, location of system in relation to_wells,,buildings, etc. must be placed on reverse side.) NEW INSTALLATION: lNo septic tank or seepage pit permitted if public sewer is available within 200 feet,} PACKAGE TREATMENT [ ) SEPTIC TANK f ) Size----------------- ........-........_.._.: _ Liquid Depth ............•--------.....�. Capacity .. . ... . ...... Type ..................... Material............- --.-- No. Compartments ..................... Distance to nearest: Well --- -----------------------------Foundation .._._...._.........-.. Prop. Line --------•---.----..-.,� LEACHING LINE [ ] No. of Lines Length of each line_...:..... ... ..:.. :..... Total Length ........................... 'D' Box ,.. Type Filter Material ---------------_--Depth Filter Material ---• -...._...__.._....._-..------_---._-- Distance to_- nearest. Well ........................ Foundation Property Line ......................... SEEPAGE PIT [ j Depth --_-_-.-. Diameter ..---------_.__ Number ....-- ... .......... .... Rock Filled Yes ❑ No ❑ :a Water Table Depth ----------- -------------- ---Rock Size ----...............----_------- � Distance'to nearest: Well ...... -------------------------Foundation _......... Prop. Line ........ ; REPAIR/ADDITION(Prev. Sanitation Permit# ---------.................::...__.__..-- --- Date ................................ Septic Tank (Specify Requirements(. ............ ---- ----- --------------- --------------•-- -----------___---------...---_----------...._._..._.... Disposal Field (Specify Requirements) `.._.,;z__y� e�f�� --- _..C��._. -!`.$ .Y./ .�- .................._.. ............... -...._- ......... (Draw existing and required addition o`r► 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. Home owner or licen- sed agents signature certifies the following: "I certify that in the performoncexof the work for which this permit is issued, I shall not employ any person in such manner l as to becomes je t to Workmcen's Compensat o�n laws Signed .:.. ... .. f,Qt-C• --�---•-- •- •----------------- ---• ----------------.....--... Owner Title (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .._ � ... ........ DATE �,'.�-1�"� .• . BUILDING PERMIT ISSUED .-......_. ._.,. ,..... ---------- ----- ----- ----- ........DATE . ....................................... ADDITIONAL COMMENTS __,.....:.. ............-- ------------- ----- - --------- --------- ----- ---------------------------- ----------- •----------------------------- Final Inspection by: .. - -.'Date ...../... .`..�Q...�-_ -y SAN JOAQUINr,-toCAL,-HEALTH DISTRICT