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FOR OFFICE USE: ` APPLICATION FOR SANITATION PERMIT Permit --------- ...................... ••--- .- (Complete in Triplicate) .......... Date Issued/,'1-17-0-This Permit Expires 1 Year From Date Issued 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 County Ordinance No. 549 and existing Rules and Regulations: 4 Jk--. O '�`'C� '-- Y CENSUS TR ��------..... JOB ADDRESS/LOCATION .. --.:._ .----'-- -- --- ----• - •-•--- •• .. ..............:••-- Owner's Name -- - -� .�'-e-"e- ----• -- - � .------•------------- - - _ Address e --- g- ��3'G !� :.License # fi- Phone Contractor's Name ._!-=►'. ,.t -r1 - Installation will serve: Residence'NApartment House❑ Commercial []Trailer Court Motel ❑ Other ------- ---------' ------------------•- Number of living units:__._ Number of bedrooms _.._Garbage Grinder ._:.__ _- Lot Size _ ._________---------.-- -_ Private ❑ Water Supply: Public System and name _- -------- Character of soil to a depth of 3 feet: Sand 1�1 Silt ❑ Clay ❑ Peat ❑ Sandy Loam ❑ 'Clay Loam :❑ Hardpan ❑' Adobe ❑ Fill _Material ..._._.. --- If yes, type --------- _-- - -- ----- ---- (Plot plan, showing size of lot, location of system in relation 'tb wells, buildings, etc. must be placed on reverses e. NEW INSTALLATION: 1No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT { ] SEPTIC TANK{ J Size -------- --- - ----- Liquidp _ Material_ -- -.---- No. Compartments --•----•----•.-- -.. Capacity .., -_ ---- ----- Type -;- - ---- ----'- Distance to nearest: Well ..__----------- I Pro Line .............:........ - ----Foundation -------- -------' p U �...._ Total length _.� ..__.•---••-... LEACHING LINE [...> r�No. of Lines ___...__.� -- Lenth of ea��ch line___.._..--- -•- �y-lam 'D' Box ___��.. Type Filter Material _.:ST•�`.'��I-Depth Filtef Material._."�_.�....___..__.-�7.---- ........ --U -- PropertyLine Distance to nearest. Well .. - -- Foundation Number _._. ._.__._ .. Rock Filled Yes ❑ No �1 -------- Diameter ------- SEEPAGE PIT [ ] Depth ..4 --- --------•---- Water Table Depth...................... ------Rock Size ............ ------ ----• ------ Water .. ~Foundation'_:`. ,.. 4 -`Prop. Line ---------------------- Distance to nearest: Weli .:-_---•......................... Date---------------------- REPAIR/ADDITION (Prev. Sanitatio f Permit # ..........:.. ) Septic Tank {Specify Requirements) ------ --------- •---------------- :; ----- ------------ . ..................--__.......•_-------••-•••_ - ;. . - ..... ......... Disposal FieldSpecify Requirements) -1< _/` _ ' r-, Asa...---._......•••................. "" ". � " �� (Draw existing and required addition on reverse side) I 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: "I certify that In the performance of the work for which this .permit ls`issued, I shall not employ any person in such manner as to become subject to Wor an's Compensation laws of California." Signed Owner '%� - G� • _. .. _---- .. ------ By-'-- .... - (If other than owner) FOR DEPARTMENT USE ONLY 11 —�-- - DATE %.�.......... ---- APPLICATION ACCEPTED BY _&± %�---------------- - _ BUILDING PERMIT ISSUED ----- - .__. ---------------- ------- --- --- -- - - ADDITIONAL COMMENTS ._/_ ...� ......rte �" -�- ' --- -- --------------------------•------------ . •---- - ------------------------------ ---------- ------....---------------- _ -- -- --- -- ... _--------- -•• .. ----- --••................•---•--------------- Zg� �9 Final Inspection by:.................. -3 - - - ..... Date '.....L. i SAN. JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M