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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. ........... ......... .............................................. Date Issued ......- ..................................... ---.. ----• ..._..:--- This Permit Expires 1 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- :A described. This application is made in compliance with County`Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/L TION f7, Lp/, :f ..............CENSUS TRACT ' Owner's Name .............................•------... ,� .Phone Address ........ ._...._... ....eCity .lL.G? /•�?r :... �. .57 Contractor's Name �. , rte• .......................License#0717/.-0 g phone"i-� Installation will serve: : -Residence Apartment Housefl Commercial oTraller Court f -Motel ❑Other............. :.. . .:........ _ Number of living units:... ___ Number4f bedrooms .�.....Garbage. .......G _r - inder l f'. Lot Size Water Supply: Public System and name .............. Silt .._.........---•-----•----...._........_..........................................Prlvotek Character of soil to a depth of S feet: :Sand❑ o` Cioy o Peat❑ Sandy Loam p Clay Loam D Hardpan p Adobe Fill Material ........._.. If yea,type.—t ........ ............ (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,j .. f PACKAGE TREATMENT j ] SEPTIC.TANK f .... . ...:............. ................... Liquid Depth ................... , ... Capacity ------ ......... :.Materiai_..----•----•------ No. Compartments .... ..:........... ... 6- - Yom..,..-..�.,.,...,.._,,..- J - Distance.to nearest: Well ..................................:.Foundation .-- Pro Line p. ...........F LEACHING LINE [ No. of Lines `.-........ .......__- Length-of each line............. •. .�- -•---- Total Length ............................i 'D' Box ..... -`__Type•Filter_Material ...............•....Depth .Filter Material ..-----......---•--........_..:.........:... Distance to nearest: Well Foundation ........... . Property Line ..................... SEEPAGEPIT - -,....,..>....... , ..._... - �.�.:_ -,,., -- - [ Deptii Diarr►eter umber Rock Filled Yes © No Water Table Depth _..... - .Rock Size ..:... - ,� -- „ Distance to nearest: Wel! --------•-•---•-------------------------Foundatian .................... Prop. kh-16i ..................... REPAIR/ADDITION(Prev. Sanitation Permit# ...........:...... ........ Date Septic Tank {Specify Requirements} -------------- ---•- C� -- ..............................•--••-•---• !!t1 Dispos Field (Specify eq.uire a sj ._.. - , /..... --- -----•--- ................-........................ ----------------------------- ------------ ----------- -------------------------------------_.............................(Draw existing and required addition on reverse side) ~' I hereby certify that 1 have prepared;this application and that the work willIse done in accordance with ion�`Joagvii County Ordinances, State Laws, and'Rules and Regulations of the San Joaquin Local Health:District. Home owner of Ikon- red agents signature certifies the following: "1 certify that in the performance of the warts for'which this permit is Issued, 1 shall not employ as to become subject to Workman's Compensation laws of California." p y any Person in such manner Signed _. Owner BY ------•---_ Title other than own r) -_ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 8 F BUILDING PERMIT ISSUED - '- - = -------- ------ DATE ._......_ ., .—..__7:.:---------• . DATE ADDITIONAL COMMENTS -•-•---'.................... ..........4 ` •---•-• ---••-------•----------•----------•--- ------------------------ --•- ti . ---------------- , . Finol Inspection by: _._-.-.-- - - - ._-. ._ --------•-- -._Date ..:..�--.��_....----� - EH 13 2h 1-6& :- SAN JOAQLKN LOCAL HEALTH DISTRICT 8/7h 3