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_--- APPLICATION FOR SANITATION PERMIT .... (Complete In TrIpIlcate} Permit ............................................... This Permit Expires 1 Year From Date issued Date issued. Application Is hereby made to the Son Joaquin local Health District for a permit to constrict and install the work hereto described. This application is made in compliance with County Ordinance No. 544 and existing Rules and Regulations, JOB ADDRESSAOCAT10N ..................... ................ ..CENSUS TRACT .......................... Owner's Name --- .-__ ._._._............. Phone Address ,._*-................'City�-._._.Contractor`s blame --- y " ..............---._.__-----_--_- -. -.License#�iXn�.. Phone Installation will server !dance }'Apartment House0 Commercial =)Trailer Court j] Motel ❑ Other Number of living units:__. ......... !Number of bedrooms .._..... Garbage Grinder ............ Lot Size •------------...�....:.:... Water Supply: Public System and name . .......................... ......_................... ..._-•.... -.......................... ............... Private 0 Character of soil to a depth of 3 feet: Sand 0 Silt (] Clay Q Not ❑ Sandy Loam t] day !roam [3 Hardpan (] Adobe [] Fill Materiol ............ If yes, type k (Plot plan, showing size, of lot, location of system In relation to wells, buildings, etc. must be placed on reverse slde.) NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer Is available within 200 feet) { PACKAGE TREATMENT (] SEPTIC TANK( Size ------------------------------------------------ Liquid Depth ...._.................... Capacity --- T Material ..................... No. Compartments Distance to nearest: Well Foundation .._..---------------•-•----------. ...................... Prop. Line ....... i LEACHING LINE No. of Lines . Total Length W � j --------•----•----...... Length of each line. D' Box type Fitter Material .. ..Depth Filter Materia# ... .........................r.... f ,, i Distance to nearest: Weil ..... i ......... Foundation ________________________ Property Line ................... .....Y SEEPAGE PIT (j Depth ..................... Diarneter:._::Y,._,rNumber— Rock Filled Yes ❑ Nolc, { Water Table .::—..;. - ` .-..:....Rack-Size..................... { —Distance to neorest, Well -_- ....._..............................Foundation--_................. Prop. Line ......... ....... �._1 REPAIR%ADDITION(Prev. Sanitation Permit# ......... ................................Date........................... 2! { Septic Tank (Specify Requirements) ......... _............_. -_---..._....�....... .-------- _... Requirem........•._.- ..........gisposal Fiala(Sy ..,. i ------------••-•................---.............-•---....---- ......................... •-•------..................... -------------- ......... ..•-----......_..................... i r .................................................. ........ (Draw existing 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 Sas JoaquM County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Homs owner or licen- sed agents signature certifies the following: - "I certify thpt in the performance of the work for which this permit Is Issued, i shall not employ any person In such manner as to becarn J subject to Workman's Compensation laws of California." I - Signed .... i. ............................... .-------------------------- Owner BY ............................ $i tle ... _.... _ - ...................---- ................ i Ilf other an owner) , APPLICATION ACCEPTED 6Y �.-; �:.................. ..... ............................... DATE BU{LDING PERMIT ISSUED .... ,--•..................................--------- ._..... --- .............---............_......DATE ......... ........... .- ..........:....... t ADDITIONAL COMMENTS ..__.._.. .............................._.-_........__..... .._.__._..,_.._......._..... i ._.,.......................:............ ----------- .............. .. ...........................,................. - ... i -•-- ......._.............................. Final inspection by: ................. ............................ Dote . EH 13 211 1-6v•5mSAN JOAQUIN LOCAL HEALTH DISTRICT' 8/7h 3M 1 s