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FOR OFFICE USE: APPLICATION FOR SANITATION PEr 'IT i ----..._...-------------- -'------------- ----- \.e' %s/ o.hPermit Nl-3.-Y � _ (Complete in Triplicate) -- __-_--_.__ 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 lication is made in compliance with County Ordinance No- 549 and existing Rules and Regulations: JOB ADDRESS _Z._.... ---- - ----._-_-, ----- ----45—e -CENSUS TRACT __`S y-- ----- --.- Owner's Name ---- -- - - - --------- ------------ ------- ----- - - - Phone --- -----------------...-------- Address 1 ----- ----- - - --- ------ - - — - Cit' - Gu L - Contractor s Name ----- - --- - --- ---------------------------------- License # 1"3X_ Phone - Installation will serve: Residence Apartment House(] Commercial ❑Trailer Court ❑ // Motel ❑ Other ...------------ ---- ---------------- .. Number of living units: ---.(.___ Number of bedrooms .._--_Garbage Grinder _--_------ Lot Size ....�It <�-�--.--- Water Supply: Public System and name ------------------------------------------- ------------ —------- -•-------------------- _-------------------- Private Cr -' ti Character of soil to a depth of 3 feet- Sand ❑ 1bilt [] Clay ❑ Peat ❑ Sgndy Loam ❑ Clay Loam [] Hardpan 19/ Adobe ❑ Fill 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 see ge pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTI TANKq(�/J q p Capacity -b�-aCTy-.-_.-.. Material---e-"'�:c— No. Compartments-•-.-. /i Distance to nearest: Well --- _-_.'----------_.___--Foundation ----- Prop. Line --- s__---_-..._ LEACHING LINE III/ No. of Lines ----------3-------- Length of each line-------VD_.�--_.-.__ Total Length -----.L 'D' Box --------- Type Filter Material -------- Filter Material ----- O o r r S' -9 .,` Distance to nearest: Well ------------------- Foundation Foundation----__L_CL_-__-_- Property Line _._...___-. - s l SEEPAGE PIT Depth --_ .J --___ Diameter __ M_ Number ---- _--_.ral..__------- Rock FilledYes No Water Table Depth--------------�P- 1---_ ----------------Rock Size ..L1,2 ----- '- r-3------ ! Distance to nearest: Well-----I-----b-O -----------_------Foundation -.1-11_-- r ..----- Prop. line --- �-----.--_- it REPAIR/ADDITION (Prev. Sanitation Permit #--------------- ---------------------- ---- Date --------------------i _-) P Septic Tank (Specify Requirements) ---- ----- ----------- ------- —------------------------ ------- -------------- ----- - ------ --------- Disposal Field (Specify Requiremenfs)--------------- -.--------- —--------- --------- _------ - --------- - T ------------ -------- -------- -------------------------------- ...... -- - -- ----- --------------------- ----------- (Draw existing and required addition on reverse side) I hereby certify that 1 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: "1 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 Workm.an- Compensation laws of California." Signed---------------------------- --- ------T- --- - ---- ------ - Owner By -... .----------- ----------------- �- -7itle _ Q -Q a`- -- ----------- ---------------------- By - -- -- ------- (if other than owner( APPLICATION ACCEPTED BY -. BUILDING PERMIT ISSUED ---- ADDITIONAL .-ADDITIONAL COMMENTS -.--_. -------_.............. ---------------- ----- Final Inspection by: ti CAAI In Ar1111A1 IMAI UCAJT MCTDIr _. DATE _ ----DATE ------- ---