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FOR OFFICE USE: i1�1 APPLICATION FOR 'SANITATION PERMIT ---------- ---- ------ --- w. � �,' ( 6mplete in Triplicate) Permit No. _71------- ...... + ------------------------------------ ----------------r _ . "'`�---This-Perrinit'Expires 1 Year From Date Issued Date Issued -- 1 ��. %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/LOCATIO "`` -+ = = %7 ------------------------------------ -CENSUS TRACT --------------•----------- ----- ---=- ------------------Phone Owner's Name --- yam,,-,�.-- ---- � ------------------ - �� ----------------.. , Cit ------------------------------------------ ------------ _ oeAddress -----CLQ_- y/ - --------------- �-=-�-, '�- t-------�,..�----------- -------•- • fY --- -- ----------- ----/-�-i ---- - - Contractor's Name ____ __ _ ~/ License #/ �' Phone r Installation will serve: Residence[ IApartm nt House❑ Cummer ❑Trailer Court ;❑ r+' Motel ❑ Other Number of living units:--/----- Number of.bedrooms- Garbage Grinde----- --- Lot Size ------- Water ------Water Supply: Public System and name111 el------------------------ --------- -------------------------------•---- Private i f ---' -5...,fi Character of soil to a depth of 3 feet: Sand'❑ +Salto Clay ❑ Peat C] Loam ❑ Clay Loam;❑ �; Hardpan ❑ Adobe Fill M 10 aterial ------ - If yes;type -------------------_--_____ A .1 �. • r (Pklotplan,showing-size-ofwlot;..location of systemlin relatior�o�wells`building�et�c' 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 [ ] SEPTIC TANK:[ ] f Size----------- w--.--_-_-------------- - ---` Liquid Depth --------------------------- ( b # Capacity - Yp p �------------------- T e �--- -- � ''Material--------------------- No. Compartments -----------------:---- Distance to nearest: Well ---------------- -- f�each line---------------------------- Total Length ----------- ----------_--- I,,.� YP -------- -----De -------------.-------------•---------------- f � V 'D' Box ------------ Type Filter :Material Depth Filter Material r • If i � 7 I Distance to nearest. Well------------------------ Foundation ------------------------ Property Line --_-_---.---- ...... r SEEPAGE PIT'S;[']" Depth .#--------------'"Diameter --_----_-_-#_,_ Number .--_--.-------.- ----------- Rock Filled Yes ❑ No ❑ Water Table Depth -------------- " ---Rock Size --------------------- Ii # Distdnce to nearest: Well -----'_______________--------------------Foundation -------------------- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# -----------114 Date -_-----_.--.-----__.---_--_-_-_-_-) Septic Tank (Specify Requirements) ------- - --------------- - -- -- ------ ------------- Disposal Field (Sp Requirements) --- I- --------------------------- ------------ ------------------ --- --------------------------------------------I--------------------------- -------------------------------------------------- ------ C (Draw existing and required addition on reverse side) t I hereby certify that I have prepared thi 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 is issued, I shall not employ any person in such manner as to become subject to Workman's Compensa On laws of California. Signed -------------------- ------- ...... ------------------- f ------- Owner 4 BY - ------------------- ', `' * ------ ------- Titlek; --------a