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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT Permit No. .......... (Complete in Triplicate) ........... ' Date Issued -.'._�.... � ................. This Permit Expires 1 Year From date Issued Applicatioh`is hereby, made to the Son Joaquin Lotal Health D•istrict'for}a permit, to c6hitruct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .. . . -0a/, ti ------ ----------•........ ... ..........CENSUS TRACT ............_..:.......... Owner's Name .._... dl..................•-••--.._.---..._._.-....--- ..................................Phone ..----._........_..._ .............. Address ..- ... J�1hfT _... Gry ' '/fin l�- ::-_ ..__...-:_.:-- ------------- Contractor's Name ._. ��.._: �( --------_----•--- -- _._------_.License -- Installation will serve: ResidenceN Apartment House 0 Commercial ❑Trailer Court ❑ Motel ❑ Other ......-_--_•-•________________ Number of living units:--_ ... Number of bedrooms-.'-. _---.nGarbage-Grindery/Ve.... Lot Size -........ Water Supply: Public System and name ---e-04-;( 4 ''.- -------------- -- .............Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Cloy C3Peat.❑ 1 Sandy Loam ❑ lCiay Loam•❑- -� Hardpan [� Adobe'F Fill Material -_._..?;.-. If yes, type ....... ................. (Plot plan, showing size of lot, location of system in relation #o 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,} 9� PACKAGE TREATMENT SEPTIC TANK l Size.--. .........._ Liquid Depth k y , Capacity .. -..,-`Type - � �. MateriaF.. :..::' ...... No. Compartments ................... �t Distance to nearest: Well ............... _.___.foundation ....... Prop. Line ................ F LEACHING LINE ' �,• No. of Lines - .. . _ ._ Length of each line >........... ..... ._.... Totdl Length _-._______. _. R 'D' Box ..... . ... Type Filter Material __._-_ __-.....`:"Depth Filter Material '.... .......................... r Y.[]�`. _ _ ce to nearest: Well _..•-------------------- Foundation ..-.------ _-...... Property Line Dist&ri SEEPAGE PIT Depth . • ._ Diameter ................ Number- .-.- ------Rock Filled Yes ❑ No Q Water Table Depth ------------ ---------------_ ._._._..-----• -.Rock Size _... --•---- ............----- � —Distance to nearest: Well ............... .................... Prop. Line ................. 3. REPAIR/ADDITION(Prev..Sanitatio'n-Perrymit#`---'-"-- ------------------- 1 ------- Septic Tank (specifRequirements) ..... ... ........ x �G _...---... - --iremenfs1Disp 5 ecifY Re u - / --�--- ----- --------a! Field . !l ------------- .....-- ---. _ .....--- -------------.- (Draw existing and required-addition on reverseside) hereby certify that I have prepared this application and-ahhat_the•-work will be done in accordance with San Joaquin County Ordinances, State Laws, and_Rules and Regvlations of the San Joaquin Local Health District, home owner or Mean. sed agents signature certifies the following: i. { "I certify that in the performance of the work for which1this permit is issued, I shall not employ any person in such manner , as to become subject to Workman's Compensation laws of California." Signed . .... ....,........ ...... ..... ---- --• - Owner �;••-------------- - B Title Y .. (If than owner) l FOR.,;'DEPA&YMENT USE ONLY APPLICATION ACCEPTEDk,BYrp. . . ...... .. ... ......---- _.--- - --•-- DATE ._.. ...- : BUILDING PERMIT ,ISSUED -_.'••:�^••_ - -..-•---- ....... ... ......... ............................... ..............DATE .. ..--- ---••- ADDITIONAL COMMENTS ....'. ........................... . .. .......- .-._---------- •------------------_ i - --.-.-----. Final Inspection by;:...... \ -_- _ -................. .-.-- - -- --•-Date -� Z � ._. .. � _.. SAN JOA OCAL HEALTH DISTRICT 13 24 _ ------------- ---