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FOR OFFICE USE: f APPLICATION FOR SANITATION PERMIT _ ................................ :.... �. ............................................. {Complete in Triplicate} Permit No. .. ...........g/ E................................I........................ This Permit Expires 1 Year From Date Issued Date 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: JOB ADDRESS/L N ...�1�, ... . .. CENSUS TRACT � . - ... ._.._ .. . . .................... Owner's Name ............ .��.......__� .................................. �.. CE.Phane ��1..1...�`�r�..Y..._......-rte Address ._..._. ......... City ---------------------.......................... . Contractor's Nam ...............................License # ,Y .1-?.._. Phone Installation will serve: Resid ce[]Apartment House C] Commercial ❑Trailer Court Motel �ther ...........-•......................••....... Number of living units:...�_ ----- Number of bedrooms ............Garbage Grinder ......... Lot Size ._.!�:��.......:........•. � Water Supply: Public System and name .................. ...... Private a;-, Character of soil to a depth of 3 feet: Sand❑ Silt❑ - Clay E] Pe at❑ Sandy Loam 0 Clay Loam 0 Hardpan ❑ Adobe ❑ Fill Material ,1 ._.,.- 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,j PACKAGE TREATMENT (;] SEPTIC TANK ] Size..................................... . .. ..... liquid Depth ........................ Capacity + Type Material............. No. Compartments Distance to nearest: Well_, ................... Foundation ......... Prop. Line ................ - LEACHING LINE n [ ] No. of Lines ---------•-------------- Length of each line................... ...... Total Length _........................... 'D' Box ............ Type Filter Material ....................Depth Filter Material i Distance to nearest: Well ........................ Foundation ................. Property- Line SEEPAGE PIT Diameter ................ Number Size _..-- --- Rock Filled Yes Q No ,.....�.e„_ [ ) Depth ............ ....... _ Water Table Depth ................. ............... -----------.•• Distance to nearest: Well ------- ----------_-_ ---------_---Foundation ..._............I.... Prop. Line ..................... F REPAIR/ADDITION(Prev. Sanitation Permit ..... DateP fY q ) ....../4,�, P1Z7..r v- ----Septic Tank (S eci Re uirements . .x! _ -.��--!;-�_•__.��-.��,� � Disposal Field (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 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 BY ......... p•� (If other th owner) ; FO DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.. •• ...................... DATE.. ,..7... BUILDING PERMIT ISSUED ............................_...............................................................................DATE, . ._...--......................._.._..---- ADDITIONAL COMMENTS ...........I.............. .......................................... ..............:.... . .......................... ....-•---- -- ... • ................... ..............I........ Final Inspection bYx �_ --....... Date:'.... j SAN JOAQUiN LOCAL HEALTH DISTRICT C0 F- N 13 24 i_-Aa o_ eu _