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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT . ........................ ................... V.... (Complete In Triplicate) Permit No. .../- ............................................... Date lssued .4"a.-// ...,--,_•._-,•,--.._„•___.-__.•,•,•_._,--------, ..................................... ---------- Thispormit Expires I Year From 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 mc de in compliance with County Ordinance-No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION _/ ............xac;4..................CENSUS TRACT ..S41............. Owner's Name .... ...................r..... ....... ....... ..._......Phone................................... Address ....... -----------------------------------------•-------------.-_-.city ....................I........ .................................... Contractor's Name -_- --_-----__-- Phone Installation will serve: Residence 0 Apartment House 0 Commercial[]Trailer Court 0 Motel 0 other ............... ................ Number of living unitsi..../ Number of bedrooms . _.Garbage Grinder*/410.. Lot Size Jaivw-.�-- -----_---------- Water Supply: Public System andI name _................... ............_...... ..........................................Private Dq Character of soil to a depth of 3 feet: Sand I-] Slit❑ Clay 0 Peat❑ Sandy Loam .0 Clay Loam Z I ol Hardpan g?O"*Adobe C1 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 seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ I SEPTIC TANK T ) Size-....._._..._..... ...................__ Liquid Depth .................... Capacity: ............. Type .............. ..... Material.-----------........ No. Compartments ...:.................. Distance to nearest: Well ....................................Foundation ................ Prop. Line............. ...... ' I LEACHING LINE I No. of Lines ........................ Length of each tine_............_..........._. Total Length ............................ • V Box ._I........_ . ...................... Type Filter Material --------------------Depth Filter Material .... ........... Distance to nearest: Well ........................ Foundation ------- ................ Property Line ........................ SEEPAGE PIT Depth .... ............... Diameter ............. Number ................ ... Rock Filled Yes 0 No [3 WaterTable Depth ..............................................Rock Size ..............._...... Distance to nearest; Well ........................................Foundation ......._........... Prop. Line ................ REPAIR/ADDITION(Prev. Sanitation Permit#............................................ Date .....--.--._.---.-.....-..-------.1 Septic ......................--------- Septic Tank (Specify Requirements) ------------------�f./-----------------------...........ir------------------------------------- ........................ Disposal Field (Specify Requirements) ..._0.46d...... ......0009.:.;W70........... ................................. ....................... ........ ................... ...................................... ............................................................................ I I - ............. ............................. ...................I....!-;....... ........__----•-.._....................................------- ............... ..... . 1(Draw a'xistihg 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 C*4nty Ordinances, State Laws, and Rules and Regulations of the Son'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 subject to Workman's Compensation laws of California.” Signeld :=--...-------------- - ------------ ............................. Owner ..... . By{_............... . . .............. ............... . . ............................. Title)�th an own FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY... ... ....... ........ .... ------------ ...... ...------•----•• BUILDINGPERMIT ISSUED ........................ ................................ ........... .......DATE --------- .......... .................. ADDITIONALCOMMENTS................................................................................ ......_...... .................. .......__...................... ...... • I......................... ........................ ............................................ ------ - - - .. ......... .. ..................... ................................ ......... ................................. ........ ......--••--......---•- ---•.. ..... ........... ------------------------------------------------------ 7 . .............. .. .......... ........................I....... ............... Final Inspection . ...................... .................... ..................... ............Date _...... .... SAN JOAQUIN LOCAL HEALTH DISTRICT' E. H. 9 1=68 Rev. 5M.