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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ,,.. Permit No: -�-------•--,.------• --- ------ ---- ------------ ---- -----------"--- (Complete in Triplicate) __ _ _ ----- p Date Issued ---- This Permit Ex fres l Year From Date Issued ------- --------- -- --- -------- --- ------ -------- N 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: k �! �Sr ENSUS TRACT ----------- JOB ADDRESS/LOCATION . �1`� 6 ---- Phone 9l F Owner's Name - -- -- Address '- �- Cit Contractor's Name ----- _ -----License #vrG-7171----- Phone _ Q Installation will serve: Residence XApartment House❑ Commercial ❑Troller Court ;❑ I MotelQ Other -------------------------------------------- Number of living units:- - --- Number of bedrooms --:7-----Garbage Grinder'^) -Lot Size Y - Private i Water Supply. Public System and name - _-- Clay Peat❑ Sandy Loam ❑ Clay Loam ;❑ Character of soil to a depth of 3 feet: Sand'Q Silt❑ Y ❑ � Hardpan ❑ Adobe Fill Material ------------ if yes, type --------------------M.------ location of system in relation to wells, buildings, etc. must be placed on reverse side.) )Plot plan, showing size of lot, Y I NEW INSTALLATION: INo septic tank or seepage pit permitted if publicsewer is available within 200 fe�t,} _' SEPTIC TANK: Size- X� x �h Liquid Depth ---4-------•----------•-- 1A PACKAGE TREATMENT f ] IM Gam[ ` --- Material No. Compartments ----- - - -------- Capacity/Ac- ._- TYP / iI I Distance to nearest: Well .....!M°---------------- G� r - P• +-•--------- ---Foundation --._.-------------- Pro line .----. S`! - -- ----- Total Length:I_Ax, i LEACHING LINE No. of Lines --_-aZ-- ------------ Length of Heath line_.---_ - ------ - 1 Type A -_ Depth Filter Material ----- ��--•---------------------•- 'D' Box - _---.__.- a Filter Material ---- --------- - -- kp � SIM �� Distance to nearest: Well --d-V-------------- Foundation -- 0--------_. Property line --_"S__----__•-------- De Depth _o ---_-- Diameter ----- --- Number -- -------------- Rock Filled Yes Pr No C# . SEEPAGE PIT - p �r i % .. Water Table Depth -----------<-a------------------ --=----Rock Size ----------------------------- ®v' a / ---•---- Prop. Eine ----- -------------- Distance to nearest. Well ------1--------------- REPAIR/ADDITION(Prev. Sanitation Permit# --------------------------------------------- Date ----------------------------------) Septic Tank (Specify Requirementsl -------------------------------------------------------------- ` Disposal Field (Specify Requirements) -----------------------------------------------—---- ------------- - ----------------------------- -` -------------------------- --- ------------------------------------ ---=--------------------- ---------------- - ' ------------------------------------------------------------------------------------------------------- ------------------------ -------------------II------------------------------ (Draw existing and required addition on reverse side) I hereby certify that 1 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: "1 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 become subject to Workman's Compensation laws of California." Signed ------------------ - Owner - - --------------------------------------------------------------------------- ------------------ Title ------ ------------- (If other than owner) OR TMENT USE LY _ !. APPLICATION ACCEPTED B --------- ------- DATE ��" j BUILDING PERMIT ISSUED --- -------------------------------------------- ----------- --------- ------- -- DATE � - --------- ---------------------- ADDITIONAL COMMENTS ------------- -- -------------------------- ---------------------------- - ----------------------------------------------------------- - ------ JL=-2_s_17_ _ ----- _0.4------ve ��6�- 34-;w----- -- - -------- -- �I F---------------------- ----•- - -- iI - ---- ---- ---------- ' Fina! Inspection by: ----- - -------- ---------- ------------------- ----------------------- Dates 32N JOAQUIN LOCAL HEALTH DISTRICT- E. H. 9 1268 Rev. 5M I�