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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - `` ?e........................ Permit No. ...7��=_.�.�� (Complete in Triplicate) ...._...•.___.._.. .......................... This Permit Expires 1 Year From Date Issued Date Issued ._517 517 .:�Y Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with Co my Ordinanc o. 544 and existing Rules and Regulations.- JOB egulations:JOB ADDRESS/LOCA I . -- ........ . . ...... -- .� ENSUS TRACT . Owner's Name .... .......... " . . fi..... ;�;................ ......Phone ��.. ...... Address ._.----.: ... 1 ..:.,.... CitY- - -------- ............. Contractor's Name ... �r.....:. .... ,-•. -- �.--.Licen e # ................:....:.. Phone Installation will serve: Residence;<Apartment House fl Commercial ❑Trailer Court ❑ Motel ❑ Other ------------------=------------------------- `� .. Number of living units:.__...._. Number of bedrooms----7.____Gprbage Grinder .:_.._..____ Lot Size .cz� CZ.._.__.____� Water Supply: Public System and name .....................•--...............:.......................................................................Private, Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay: ❑ Peat❑ Sandy Loam' Clay Loam 0 -Hardpan ❑. Adobe '❑ Fiil Material ...... 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 ( ] SEPTIC TAN iae..... 1L9. . ��.:.....:...... Liquid Depth -•---------- Capacity�� ...... Type14jf4,1f4kS Material_ ._. No.. Compartments ....a�?. . ...'. Distance to nearest: Well .. � l� r 44a Foundation ..... . Prap. Line..._44a... :. .............. LEACHING LINE No. of Lines �.............. Length f each ine._S .. Total Length r D' 8ox -----1✓__-:- Type Filter Material :-- --.Depth Filter Material -l :`_f..................... .. Distance to nearest: Well �. : Fou anon .....� �....... Property Line �d SEEPAGE PIT ,[ ] Depth .................... Diameter ................ Number ...--------•--•:--------•........—Rock Filled Yes ❑ No Q Water Table Depth .Rock Size Distance to nearest: Well _Foundation ------------•-----••----••------•-•---- .................... Prop. Line ..................... REPAIR/ADDITION(Prev. Sanitation Permit# - ....... Date ) I } Septic Tank (Specify Requirements) ---------.......:...--------- .••.-_------............,__ : Disposal Field (Specify Requirements) ..............-•---......... •--•..................... ................ ................._:......................-.............. ..... --------------------------------------------------- -------------------------------- :------------------------- -----•--------------- -------•----•-----•----------------- .......................... --------------------------------------------------------w-------------•--- --------------------------------......................................................................._...._.-------•-...... _ (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, I shall not employ any person in such manner t as to bec me sub•ec orkman s Compo a on laws of California. ' Signed -- ..'Owner ..... ....................... :. By ............... Iitle _............. . _...... i (If other thanowner) (/ . _ I FOR DEPARTMENT USE ONLY r . : : _ ..:� fes- •• APPLICATION ACCEPTED BY ._� .. ��1�'.........:............. ..... -----------•..__._._...... .. DATE .............. BUILDING PERMIT ISSUED DATE ......................................... ADDITIONAL COMMENTS .................------......----=--------•...------.......................... ......-................-..........................................................................._...._...--------•_.. ---- � Final inspection by: .... .: '.Date _ ,ss... ... ........--•-- f..'� � . SAN JOAQUIN`LOCAL HEALTH DISTRICT