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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit I�o. - =- /---- --- ---- ----- ----------------------------------- (Complete in Triplicate) -------' ------------------------ Date I ss ed ._411;41,7,1--- This Permit Expires 1 Year From Date Issued , ocal Health District for a permit to construct and install the work herein Application is hereby made to the San Joaquin L described. T application is made in compliance with County Ordinance No. 549 and existing Rules and! Regulations: I J B ADDRESS/LOCATION Owners Name -- `-d_. { -�� i �.+ CENSUS TRACT _�' 't - ��'''�- - �--------------------•------- -------Phone _ ��----------- Address ----- °-----� � C4--------------- -----------• City ----- - `hGH '1 - ;--------•_.----------•---- -- ----------- ------ ---•--------.License # ---------.---- -------- Phone --I-I--------------------------- Contractor's Name ------ ---------- ----------- -------- -------- - Installation will serve: Residence flKOA"partment House❑ Commercial ❑Trailer Court ;❑ Motel ❑ Other -------------------------------------------- Number of living units:-----I----- Number of bedrooms _77�t----Garbage Grinder 4L��- Lot Size ___-- ------ --------------- Water --- -Water Supply: Public System and name __________________ ____ _ -'---- •-"""""""�` Private [' Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Lo I�m ;❑ Hardpan ❑ Adobe [Fill M _-____-__-__aterial If yes,type ---------------------1------- , �I (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed n reverse side.) I j NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feetJ SEPTIC TANK' Size-__ --------_ Liquid Depth 11 ---------------------.----- p � PACKAGE TREATMENT [ ] [ IM l' Capacity l $'a -Type = Material____ C----------- No. Compartmenits ______ _-- =_--- N Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ---------- �n1 I To#al Len ,"_"-- LEACHING LINE ¢[�.Y No of Lines ------------------- Length of each line---------&.�--------- gth 1�- --------------- 1 �4De th Filter Material --------------- --------------------------- 'D' Box _-I------- Type Filter Material ______-______ ___- p � I _____- Foundation ------------------------ Property Line. -- Distance to nearest: Well _________________ """"""-�--------""•--" SEEPAGE PIT [t,}/ Depth I______ Diameter __3'3"i1___ Number -_-_----2_____________ Rock Filled Yes '(�/ No i❑ Water Table Depth ------------------- Rock Size -------------------------------- Distance to nearest: Well -------------------------------------- Foundation -------------------- Prop. Line ---------------------- ) I� REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------------------------------- i i Septic Tank (Specify Requirements) -------------------- ---------------------------------------------- ----------------------------------------- --------------------------- - Disposal Field (Specify Requirements) ---------•- - ---------------------------------------- - ----- I---------------• ---------- - 11 ----------------------------------------------------------------------------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) 11 t I hereby certify that I have prepared this application and that the work will be done in accordance wish 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, l shall not employ any person �n such manner as to beco subject to Workman's Compensation laws of California." Owner -------.... - ---- --------------------- Title - -------------- ------------------------------------------- ----------- (if other than owner) •• FOR .DEPARTMENT' USE ONLY J i�. APPLICATION ACCEPTED BY ---- - ---------------------------------------- DATE ---7--/--------------- BUILDING PERMIT ISSUED ------------------ - -----------------=---- ---------DATE ---�M------------- -- ------------------'--_-- _------------•--------------( --------------------------------------- ----------- 'I ---------------------------- ------------------- ADDITIONAL COMM TS -----"--_-- -- ----:--- --•_"-- �____ r. - ----- --- IM---- ------------ ----------- -- ------ ------ t ' ----- - ----------- ------------------------------------------- -- --- - -------- 7 ----------------------------------------- � , Final Inspection b --- ate --- Final _ --=- -_- -a�^-- SJOAQUIN LOCAL HEALTH DISTRICT . . I E. H. 9 } 1-'6. 8,Rev. 5M