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n FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .. .....:..... ...........� . 11-...�.r.L'--. -- / (Cbriiplete in Triplicate) Permit No. ---- :........... .... ............................... 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: JOB ADDRESS/LOCATION ........ `T3J?.. ......B4 ........................CENSUS TRACT ._....--------......... :.. Owner's Name .........4.. a .r. lC� .................................. Phone ---- -•................... SgQ Address ..................--- ----- ... .--- .................I....•• ......... City _.....-•---•.. ....................... .,,Vi................. Contractor's Name ........_._ _ .- KQtS*---- .... - ---.License # . . . Phone _ Installation will serve: Residence Apartment House 0 Commercial OTrailer Court 0 Motel Other ... Number of living units:.......I_._ Number of bedrooms ___3....Garbdge :Grinder ___._._ .... Lot Size ._._.._.__ -------------•-- ....... Water Supply: Public System and name .__....--•-_--------•-------- ....... -------••--' ------------------------------- ..............Private Character of,soil to a depth of 3 feet: Sand 0 Slit❑ 'Gay © Peat❑ Sandy Loam ❑ Clay Loam n Hardpan j] Adobe Vq Fill Material _........... If yes,type ____......_................. . r (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,) r L� PACKAGE TREATMENT ( ] SEPTIC TANK Size................................................ Liquid Depth...... .. Capacity .-4 _/.'--QType Material--- �vNo. Compartments ...: .............: Distance to nearest: .Well -----40_--C..................Foundation ...f Q. -------- Prop. Line .. d__ -•.-..... Tr •� NE [ ) No. of Lines -_-------�.__.._... length of ach line.-----��....._._.._ Total Length ..�.'Tp~.............•LEACHING LI - M 4 ° 'D' Box ---3 ... Type Filter Material __ 5, __._.Depth Filter Material _v .rE-....................... ......... Distance to nearest: Well ----- .... Foundation ..1 .� . ._..... Property line "e SEEPAGE PIT [ 1 Depth ._._- ----- Diameter -- - ----- Number ---------- --...- ------ Rock Filled Yes) No .C3 Water Table Depth .•--•-- •----•-•---- Rack Size � .. ................... . .!.f.? .. j Distance to nearest: Well -_........ �.?�.................Foundation ,. �.'!�_....... Prop. Line ..'�'� --•-__-�- REPAIR/ADDITIONSeptic (Prev. Sanitation Permit# ............................................ Date .................................. Tan1 p k {Specify Requirementsl .:...................................................... .-•---••-••-.__..--•----•-------------_ ..........._....... " Disposal Field (Specify Requirements) -------------- -------------------------------------------------------------------------------------•---------------------------------------------------------------- ------------------ ........ ------------------------------------------*------------ --------------------------------------..--•------•-----•-•-------•-----•-------------•-•-•----------•----------._....---._...._._..:.. .... (Dfaw existing and required 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. 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 as to become subjectZ1oWkman's Compensation laws of California." Signed ........ -----.....--•- ----- ---- -•---•- ............. Owner By .._.. . ......0Z.. ----- .Title ........... •-------------••----------------------------•--•------- - -- (If other than owner) FO ARTMENT USE ONLY APPLICATION ACCEPTED BY -- - - --- ------------------------- ---•••-••••-•••••• DATE ' -------- BUILDING P ...__...... DDITIONAL RMIT ISSUED ....... ... .. .. ... .. ..... . ....••... .. .-•••-•--•-••-•--......_..••--••••--•-------••........_DATE _.....:..----...........--•--------•-•---- COMMENTS _..-- f . ---- --- ......-•------•----•---•------ --_. ........_ ion b ------•--- • -----------Date � Final inspect, y- ------------ : -.._. _. .---- - ----------------•----•----------•---.............-- - - ,�--- -�- • N J AQUIN LOCAL HEALTH DISTRICT