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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT . . ............................... .. ....._ . (Complete to Triplicate) Permit No. This Permit Expires 1 Year From Date Issued Date Issued .�..":.....-...... .................................I..._•................ P 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 ........ ..�. N SyTRACI' .....O. 3.��8. -J Owner's Name .._. ..................... ••. :...Phone .._. .. ......__...:........... Address .........._......_ ... . ...... ---•--• ....... city .... ........... .......:..........._. 7 .h- .. ... / �.. _ Contractor's Name Phone"::............ ..__....... ��--•- --- •- _... .....License # .. ��... ............... Installation will serve: Residence Apartment Hous e❑ Commercia Trailer Court 0, Motel ❑ Other Number of living units:---- . Number of bedrooms ..-P/-Garbage Grinder. .............Lot Size ..... ...... Water Supply: Public System and name ............:.............. ............. .............................. ;.Private r Character of soil to a depth of 3 feet: Sand D Silt❑ clay ❑ Peat❑ Sandy Loam fn----Clo,y Loam ❑ Hardpan E] Adobe-[--I Fill Material ............ If yes, type ......................... i (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 p blit sewer is available within 200 feet,) 2 A PACKAGE TREATMENT [ ] SEPTIC TANKSize...`7� .._.. ._ ... '.................Liquid Depth q..._.......•.......: Capacity �c p.O..... Type.441., Material._-.- No. Compartments �'..":........` Distance to nearest: Well ..........�...Q..............:..Foundation ...../-.P............ Prop. Line ...sem............. LEACHING LINE [�No, of Lines .-`___ ____.:_ Length of each line ..... a ____.. Total- Length 'D' Box _/..... Type Filter Material ......45.7---Depth Filter Material .._..._r.. ...................... Distance to nearest: Well ......TP.....:::... Foundation :...1-.a.f......... Property Line ...r ................9 SEEPAGE PIT [ ) Depth ... Rock Filled Yes p No C31 .._.... Diameter .... Number. .:................ Water Table Depth . .... ... .... .............Rock Size ---......................... . r Distance to nearest: Well .Foundation .... Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# ........:..................... Date ...................................I w SepticTank (Specify Requirements) ......._ : .. .......:........ ........... ..................................I..........................._N............................ DisposalField (Specify Requirements) .......... ................................................................................................................ --........................,.................................................. ------......................._. ....... .. - -� ..............................:...:.........:.............................................. ..............._._...._.. .._._._.._... . ... -_. .... .._. ..:. (Draw existing and re..quired 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 liten-i 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." !f ........... :. Owner Signed ......-- -..__........ ..... .. .. -• - -••- By ............................................. . ... ..!'t�� _..... 7 tle �ir ` ..................._._..... i (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY z .............•...............:.............'......:......... DATE ..... .--•-•--- BUILDINGPERMIT ISSUED .......................... ......... .. .-.----- ....DATE .......................................... ADDITIONAL COMMENTS ..:...•............:...... - ..................................................' ' ....._ ...: :'...__..........:.'. - ...:_:_..: ...._..... ............................................. ... . 4. ......................... _~..... .. Final Inspection bY 9 ..... :.... ..Dofe,l ... a.._� -._....._.. ._ .. ........ .. . SAN JOAQUIN LOCAL HEALTH DISTRICT