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FOR OFFICE USE: �.._.. APPLICATION FOR SANITATION PERMIT Permit No: ..7`r�..df_`.�� .............I.........._........._ (Complete in Triplicate) ....... .. Date Issued ...6..` ......................................... This Permit Expires 1 Year From Date Issued Application is hereby made to the Son Joaquin Local Health District for a per 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 egulations:JOB ADDRESS/LOCATION ..... 10�..�. .r.../ .f ... .Q./�, ....................:...:..:..CENSERS TRACT .......................... � Owner's Name .....�. .{ -;4�7 � •........_.. ................................................Phone t Address ............................................................. ._.....--•--............. City � + ------------------• Contractor's Name .__ ........................................................ L;cense # �r .� ..�.. Phone :..�;.1.12. Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court 0 Motel []Other ...................................... Number of living units ..1........ Number of bedrooms ......Garbage Grinder ------------ Lot Size J-6.....,4.E ............... Water Supply: Public System and name ........................................................................................................ ......Private ❑ - Character-of soil to-a depth-of-3-feet: Sand❑ Silt❑-- Clay ❑^ Peat❑ Sandy Loam [] Clay Loam ❑_~ Hardpan [ Adobe❑ Fill Material .... ....... If yes,type --------------------------- .. 1 (Piot plan, showing size of lot, location of, system in relation 4o wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public seweris avnilabie within 200 feet,] PACKAGE TREATMENT [ ] SEPTIC TANK,[ ] Size................................................ Liquid Depth ................... Capacity .................... Type .................... Material...................... No. Compartments ......................� y,,.. Distance to: nearest: Well ..............:.....................Foundation ..-.--- -------------- Prop. Line ------:--..---------•- LEACHING LINE [ ] No. of Lines ------------------------ Length of each line----------------------------- Total Length ............................ D' Box Type Filter Material ....Depth Filter Material Distance to nearest: Well ........................ Foundation ........................ Property Line .............. .:.-..-.-.•.--• SEEPAGE PIT [ ] Depth .-- :_--_-- Diameter ................ Number ..._._........._....__._... Rock Filled Yes ❑ . No Water Table Depth . ..............................Rock Size .................... ........... Distance to nearest.• Well ........................................ ------------ ...... Prop.'op. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ............ ......................... Date ..... ....................y 3 Septic Tank (Specify Requirements) ...--. "�' 3.�.. ..... � �C� • "'......................... i:- ........................ Disposal Field (Specify Requirements) ...:.........................•--..................---•-------------- -••-----....._.-_...---------•--------.... ..... t �. --- - _ _ T-- .. ............... ................................. (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 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, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." I' Signed ...... ....._..._._ Owner ByC } ........ ...... ........ ........ .._......----........ Title _... ......_................_...... ........ (;f other than owner) R DEPARTM NT USE ONLY APPLICATION ACCEPTED 8Y ........ ...... .............................. DATE ....._ .�""� .� ..___._.._ ._.... . ..1 ..... - ......... [ BUILDING PERMIT ISSUED --------------------•----.-- ... ........----------•-----•.. .............----------...--------...DATE .................................... ADDITIONAL COMMENTS .. ............... .._.......-----•--••------....._---... ....... -----------.._... .... ....................................................... --- ........................................ ------------------------------------- ------- .................................. ........................................... ----.Date Final inspection by: ............. " _ ry ,_,-.,.,.SAN.JOAQUIN LOCAL HEALTH DISTRICT