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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT F .. l`�L� `• �' Permit No.� — S .................................. ................. t ti {Complete in Triplicate) .._....----........ { Date Issued . .`�. .-�-z' This Permit l"ex ares 1 Year From Dot*Issued 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: �iJ qq JOB ADDl2E55/LOCATION ��..��.:.� _CENSUS TRACT ..'�-----............ _... Owner's Nome ..G . - ... ----- Phone ". J i+ Address //d.74J.. .�.`. ---- •- . .-:;.: ......City- . .............................--•.................... ResJiLicense # -6 . .x �� . PhoneContractor's Name - - -• .... ........ . ...�.:r.r"_ ` •.....Instailation will serve: dence 'Apartment House{] Com merciat❑Trader Court ❑ Motel ❑Other. --............................ ........ Number of living units:........ Number of bedrooms ...C;�....Garbage Grinder Lot Size0..1��4- ' �--••••••• Water Supply: Public System and name......--------------------------------................. ............---------........................Private�{ Character of so_ it to a depth of 3 feet: Sand❑ Slit Clay ❑ Peat❑ Sandy Loam'gf Clay Loom ❑ Hardpan ❑ Adobe ❑ 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: iNo septic tonk,or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ I SEPTIC TANK'[ ] Size.......-_- =----.. .. Liquid Depth ---.---......--•--•------- (� Capacity Type .................... material........-............. No. Compartments Distance to nearest: Well .Foundation ....... Prop. Line 0 LEACHING LINE [ ] No.-of Lines .... ................... Length of eachline-------------............... Tatal Length ...------------------------ 'D' Box ............ Type Filter Material ..............._-Depth Filter Material ........---------......... ................ Distance to nearest: Well ------------............ Foundation ..................... Property Line SEEPAGE PIT [ ) Depth ............ Diameter ................ Number - -•.. ..-......__......__ !tock Filled Yes ❑ No 0 Water Table Depth ........ ........................Rock Size ............. .................... Distance to nearest: Well ........................................Foundation ........._........- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ................................----------- Dote---------•------------- ......I Septic Tank (Specify,Requirements) ............................................................... ..............•��-..-.--.-•-•--- .... Disposal Field {Specif Requirements)l{,.'�.�...!,�,f.-__---- . -..... . ....... _.._.. _ •___•._•III ----------------------------------------- ,r ...�t, . ..... rx.d ... ,� .......... ...... ................... - (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; wifh'SanJoagvin County Ordinances, State Laws, and Rules and Regulations of the Son 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 bec �e s 6lsct.to rk n's Campe2 tion lows of California." Signed . i. .. ••........ ....... Owner Title ---------------------------------------------•-•---...__.------.._..,--- By................................ .. .............. . (if other thn owner) FOR DEPARTMENT USE ONLY --- APPLICATION ACCEPTED BY DATE .�....�. .`- •• .................... .....------....._..... ........_.......... BUILDING PERMIT ISSUED•.... .... ...............................................DATE . ......._.......................... --------- ADDITIONAL COMMENTS ............................................• k_...._.._....._._.......................--•--•..__..._•................................................._..---._..._.___...__....�._.. ...... • r ..........-�__. _.-................................... .................................................................................... r ......v..._ .�...................�... .... _ ..........-_........_....__._. ...... Final Inspection by: ...............................paie,r: + ..'. .. ...._....... ` SAN JOAQUIN LOCAL HEALTH DISTRICT r W 0 1.,Aq Rwv 5M