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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ....-•-• ------=--- • Permit No. .��.S3 17 (Complete in Triplicate) ..I.....:.......... This Permit Expires 1 Year From Date Issued Date Issued ..7J._........... 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 madq in with Coun y Ordin nce No. 549 and existing Rules and Regulations: JOB ADDRESS/LOC Tl N ..Z ._. .-elf . _ V-4F1d, --, i�47,/I�,CENSU TR Owner's Name ..-F``� -------- .Ph .! . 1... ---•-- one - Address ... ......... ---....--------- --------------------------- City -- ..... .......................... Contractor's Name . .'J ✓�� e+�._..el�it� e-C. ' ,.._..- - 1�°--�- �.- --- -- .__ .- License #vZ6'1-f'l'1.._. Phone . �.Fz20,q Installation will serve: Residence ❑Apartment Houle-[] Commercial ❑Trailer Court ;❑ Motel ❑ Other . ,° - --.----- Number of living units:..._.... Number of bedrooms -_�._Gorbage Grinder ._.-__ Lot Size ................ !' .-.._..............� Water Supply: Public System and name .. -- ---- -- ---------•...................... ...........................Private '�} Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loom ❑ Clay Loam ❑ '' Hardpa ❑ Adobe ❑ Fill Material ......... If yes,type ....................... . (Piot 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 [ ] SEPTIC TANK t ] Size... +tel . -- Liquid Depth .......................... � J Capacity,.... Type Materia e_No. Compartments Distance to nearest: Well - - ---.-_" � Foundation .... .......... Prop. Line ..__ LEACHING LINE [ ] No. of Lines Length of each line . ... Total Lengt h_r ....:............• C� 'D' Box ..:/ Type Filter Material�'°Y., _ ___Depth Filter Material ....... ... ................ ._ .. .... Distance to nearest: Well . p�.._ ' ' Foundation ......_... Pro er Line d SEEPAGE PIT [ ] Depth •...... ...................._...-.-=------...........Rock Size ------�-------.-_......-• ------ ❑ � �. Diameter Number . ...... ... .............. _ Rock Filled Yes No ! Water Table Depth Distance to nearest: Well ---------------•----- ..................Foundation --..-..... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# _-__._.- _ ..-_ Date ----------------------------------11 � Septic Tank (Specify Requirements) ..... ........... ------------------------------------ --• ------------------------- --------------.............................. ..... Disposal Field (Specify Requirements) .... ---------------------_---- ------ ............. -- ....... ----- ........... ..... ........................ .... (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in actordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Localf Neallh District. Nome owner or iicon- 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 BYE.._..-- Title ✓Z ,... ................_.. (if other than owner) -------- -- - F--- DEPARTMENT USE ONLYT_____� _—. — APPLICATION ACCEPTED --------- DATE ........................ I' BUILDINGPERMIT ISSUED ....:.......... ........ ..... ......... ...........I............... ... ..............DATE ... ......................_-.............. :ADDITIONAL COMMENTS ................. .......................... .................... •---• -------- . •------------------------------------------ ---r------------------------ ................................ - -- •....... . .... ... . ...... . ........... - -Final inspection by: .... . -- -• -- -------•--- •---------- •-=-- ..-_.._.....Date - ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT