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FOR OFFICE USE. APPLICATION IFCr,� SANITATION PERMIT rPermit o: -- - �� �,- KCompl a�n Triplicate) I� -------------------------------------- �-______ This.Permit�Expires 1 Yearfrom Date Issued Date Issued -_ _ _ -3 Application is hereby mare 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 CountyOrdinance No. 549 and existing Rules and Regulations. ATION� __ -JOB ADDRESS/LOC ----- _ - -------------- ------..CENSUS TRACT --------------------•----- Owner's NameIM-C... _-� /� Phone -----I`------------------------- Address '- ----A�Q------------------------- City Contractor's Name ------.License # Phone Installation will serve: Residence ❑Apartment House❑ Commercial :❑Trailer Court ;❑ Motel E] Other _ W Number of living units:-__�____._ Number of bedrooms _________Garbage Grinder _______.._-- Lot Siie ----- _ Water Supply: Public Systlm and name ------------------------------------------------------------------------------------------------- I� Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay--❑ Peat❑ Sandy loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ill Material ------------ If yes, type ------------------I-------- iI (Plot plan, showing size sof lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) !i NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,] ` PACKAGE TREATMENT it �i, r i [ �i] SEPTIC TANK:[ ] Size-----�,,� --------------------------- Liquid bepth .----- - .---,_---- P Y e00---= Type - - _._ o. Compartments s?l ... Ca acit _. _. __ T e �_C�rMafierial__�. 'M � S Distance to nearest: Well ______ZoQ____�--__________Foundation _---_ -/�_______ Prop. Line .__ ___ i r ! P• . LEACHING LINE N`. of Lines Length of each line-____._ ______ Total Length ��_�.> -..._._______ s D' Box6n. afiType Filter MaterialX __Depth Filter Mcteriai ------ CPU— ------------- _____ _______ Distance to nearest: Well -_�t � Foundation -----1Q__ -____- Property Line ----- ... SIM -� r-� l SEEPAGE PIT [ ] Depth __cap ___ ____ Diameter ---- Number _.___---- �_-- Rock�Filled ' Yes No C Depth Water Table i P ----14��----------- ----- - - �_ ! - - Rock Size _ _�-X ---I=- - Distance to nearest: Well -----AS .....................Foundation ----- Prop. Line ----� r f REPAIR/ADDITION(Prev. Sanitation Permit# ________ ___________________________________ Date ---------------.-____-__________._-] Septic Tank (Specify Requirements) ------------------- ------------------------------------------------------------------------------------------... Disposal Field (Specify 1Requirements) ------------------------------------------------------------------------------------------------------- I� ----------------------------------------- I------------------------------------ -------------------------------- --- ---------------------------------------------------------1--- ------------------------ --------------------------------------------- --- (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 s .� permit is issued, I shall not employ any person in such manner r as to become ct to or an's Compe ation laws of California." Signed - --- ------ _------. Owner r Title __ �. BY ---------------------------------ofI - ------- - --------------------------------- {If other Chari caner} F DEPARTMENT USE ONLY ( APPLICATION ACCEPTED 8Y - __ ._ _ DATE ___ -.�__ - --- BUILDING PERMIT ISSUED,---- - ------ -- ------ -----------------------------------------------=--------------DATE -------------•-`--------------------------- ADQITIONAL COMMENTS �I-_ �I-------------------------- ------------- -------------------------------- __//------ ---- ------------------------------- ------------------ -----------------------------------I--------------------------- ------------------- :�Ii ------ --- --- ------------------------------------------------------------------------- ----------------------]� - ---------------------------------------- --- Inspection by: - Date7--=-- .— ---- --------- SA JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1268 Rev. 5M: