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l FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT i/- 6 Permit No: . --� f. (Complete in Triplicate) This Permit Expires i Year From Date Issued T Date Issued -----_-------------------_ _ -- --.----------------_---- Application is hereby made to the San Joaquin Local Hea th District for a permit to construct and install the work herein described. This application is made in compliance with ounty Ordin ce No- 549 and existing Rules and Regulations: JOB ADDRESS/LOCA ON .-AfZ3 di ----------_-- CENSUS TRACT ---------------•--- ...... Owner's Name ---- --- - j - -------------------------- ---- -Phone-------- ----------------------.----- Address ---------------/70,0 1�, ---------. Cit ------- ---------------------------------- --- ------ _ l ---f�fil License # - - ct-3 Phone Contractor's Na -- Installation will serve: ResidenceXApartment House❑ Commercial :[]Trailer Court i❑ Mote! ❑ Other -------------------------------------------- j {�,r Number of living units:-- e_ ___- Number of b�e ours __�I______Gar ag Grinde __.___-_____ Lot SizevU---X_/J-�-----------------Water Supply: Public System and name ------- ----- ------------ Private ❑ Character of soil to a depth of 3 feet: Sand'❑ t❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ ' ' Hardpan ❑ Adobe•Y Fill Material ------------ 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,) PACKAGE TREATMENT ff] SEPTIC TANK:j ] Size------------------------------------------- ---- Liquid Depth { - . --------------------_- acit ---- Type Material No. Compartments Ica , Foundaton - _----------------- Prop. Line --.----------s ._-.#Distance to nearest: 'Well,_---------------------------------- --- \ LEACHING LINE [ ] I No. of Lines ____________________: Length of each line ________________ Total Length -----------______._...-...__ "�►� 'D' Box ------------ Type Filter Material -------------------Depth Filter Material -------------------- --------------------_ Distance to nearest: Well ________________________ Foundation ----- `.---__._________ Property Line ---------._____-________ SEEPAGE PIT [ ] Depth _.____.______ ----- Diameter ________________ Number _.______._____-- --____ Rock Filled Yes ❑ No i❑ ?� Water Table Depth -------------------- .'---- -- ------------Rock Size -------------------------------= r '-77 Distance to nearest: Well --------- -- ---`'-:---------------Foundation ____________________ Prop. Line ..------..____-_.-__:_ REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------------- -------------- Date,--------------w-----------___-----1 Septic Tank (Specify Requirements) ------ y----- ----------------------------------------------f. s isposal Field (Specify a uirements) --� :a � ` f------------------R ............................ `J --------- t Q. J -� --_A --�----------------------------- (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, I shallnot employ any person in such manner I as to be ct fo W rkman' C pen ws of California." ��- t t 5i n E---- . BY --- ------------- --------------- - _----- --- -- ---------- Title (If other than owner) r, r r. jDfif TMENT USE ONLY' i / d APPLICATION ACCEPTED BY ----- * r --------------------- ------------------------------. DATE ---- ---� �'� ------ BUILDING PERMIT ISSUED ---------- ----------- --------------- ---- -------------------------- ----- DATE ----------- ---------- ------ ADDITL NAL�COMMENTS -------- -- - --- ��--------- - -- --- ------ ---t`i� ---------------------------I------- --------------------------- - ------- ------------------------------ ------------------- --- f --------------------------------- f � 1 Final Inspection by: _____ Date ��`l_� -_Gtr- --------- SAN JOAQUI LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M