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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ..................................................... 53� (complete in Triplicate) Permit No. '----•"" ' ---•- .......................... This Permit Expires 1 Year From Dato(Issued Date issued ............. Application is hereby made to the San Joaquin Local Health District for a permit to construd and install the work herein described. This application is ado in compliar�T with County Ordinance No. 549 and existing Rules and Regulations: e JOB ADDRESS/LOC TI . .17 L . • ........ ........I..............CENSUS TRACT ........................ Owner's Name .....7//_/' <•....•---• . --••-- c. ...............................................Phone Address ------------- __.. O- ._ ............ ......,........ _ . ........City ............................................... .......................... Contractor's Name ................LicenseY..A.-7l_... Phones :,�! Installation will serve: Residence 1'Apartment House❑ Commercial❑Trailer Court Motel ❑Other-------------------------*------------------ Number of living units------------- Number of bedrooms ............Garbage Grinder ............ Lot Size ..�, -,X� o..._._...... Water Supply: Public System and name ..............................................................................................................Private, Character of soil too depth of 3 feet: Sand b Silt C3 Clay ❑ Peat❑ Sandy Loam ❑. Clay Loam ❑ Hardpan❑ Adobe 1Z Fill Material ............ If yes,type............... ............ (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,) PACKAGE TREATMENT [ ] SEPTIC TANK I ] Size............ ................................... Liquid Depth .-----_---.-._.-_....... Capacity -------------------- Type --•---_----------- Material...................-.- No. Compartments .---.................. iv Distance to nearest: Well ....................................Foundation ..__......__._..___... Prop. Line ...................... W LEACHING LINE [ ] No. of Lines ---------------- ------- Length of each line............................ Total Length --------- .................. uJ �- 'D' Box ............ Type Filter Material ....................Depth Filter Material .... ....................................... 4 Distance to nearest: Well ........................ Foundation -----.--------.. ....... Property Line ........................r SEEPAGE PIT { } Depth -------------------- Diameter ................ Number --.---.-----_------•------ Rock Filled Yes ❑ No Water Table Depth --------------Rock Size C. Distance to nearest: Well .......Foundation .. Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# ..... �D K--------------------- Date � ....... Septic Tank (Specify Requirements) ..- --- .........Ct�........ .,(Ge ... ,... DisposalField (Specify Requirements) ......................................... .......................................... ..........._....................... --------------------- ----------.--•-----------•-•------------------------•--... ------ --------•--------•---- ..........._...............•-•................................................ (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 San Joaquin County Ordinances, State Laws, and Mules and Regulations of the San Joaquin Local Health:Dislrlct. Noma owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 11 shall not employ any person In such manner as to become subject to Workman's Compensation laws of California." Signed Owner BY - title (If other than ow rl ..-....._..._.._.....-_-- F R DEPARTMENT USE ONLY oe APPLICATION ACCEPTED BY --------------- ---------_-----_-- DATE ... � :. �.=�. BUILDINGPERMIT ISSUED -----• --- ------ -•-• ....... ----------•......... .........................DATE - -- ------------------------------••--- ADDITIONAL COMMENTS .----------- --- •. ----------------------••. . -•-•-•-•--•---- ---•- ---- ---•-• ------•- ---...---- --•----••--•-----------------,..--..------._.._._....----•-. •---•-•--...-----•-----I—._..._.._........ ------- -- •-•--- �. l r 7 Final inspection by -_-- __---_Date - G. -----. �. ._ .`. ..-5................. EH 13 24 1-6 1Z,e �I SAN JOAQUIN L CAL HEALTH DISTRICT 8/711 3M