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FOR OFFICE USE:" APPLICATION FOROANITATION PERMIT Permit No. ........... ............................................. lComplete in Triplicate? s .. ............................... Data Ids ..:. _ ..... .......... This Permit Expires i Year From DOW Issued cIll the woo Application is hereby evade to the San Joaquin Locd!Health DistrictOrdinance permit and existing n0 ulesand tand RegulQtona:ein described. This application is made In compliance with Y . . ••...........CENSUS TRACT .. JOB ADDRESSAOCATION . _ .._.... ... �.r°• — -.�- .. �' 3.... � ....Phone Owner's Name ._. / - ............................. ............... f Address ......................... .......................,......._....----........_...._....-•----•.......City .... ..... ... ... ...........Phone � .......`��....... ew Contractor's Name ..o '�"� . ...License # . .�-fig.:.. .. ..:.. Installation will serves Residence['Apartment House❑ Commercial OTraller Court 1 Motel[]Other---------------------•...................... :.K�.�r .....................d f -...-----Garbe a Grinder .._......... lot Size . --- :..... Number of living unitsi............ Number of bedroom: g .......... t Water Supply: Public System and name .................................»................_....._......._ .............-.....----......._Private❑ t Character of soil to a depth of 3 feet: Sand's Silt Q Clay Q Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan❑ Adobe fl Fill Materlol ............If yes,type............... ............ , �+ w buildings. etc. must be plated on reverse side.) (Plot plan, showing size of lot, location of system In relation to wells, NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK ) «� Size.... .. . .......................... liquid Depth ........................... k Material...................... No. Compartments ................... Capacity .................... Type ..............._._.. t: Well .....................................Foundation ........ .........--= Prop. Line --------.... .. .. • Distance 'to nearest; ; each line............................ Total Length ..............................k ' LEACHING LINE [ ] - No. of Lines ........................ Length ofq 'D' Box ............ Type Filter Material .....................Depth Filter Material ........................ :; •,. V t Well �� .` ..... Foundation .......V.•........ Property tine ......�.E....:........ Distance to nearea : Diameter ................ Number ....._.................. . Rock Filled Yes � No SEEPAGE PIT ( ]. Depth ....:............... "% Water Table Depth ................................................Rock Size .......I..._..... ............ i • �....................... dation ....�Q......... Prop. lino ./= ----..-•�---•� - Distance to nearest= Well ........J..............................Foundation ....... REPAIR/ADDITION.(Prev. Sanitation Permit# ............. ................... Date _ -....) Se tic Tank (Specify Requirements) ............•-- ........ ... .. ...... ......................................... ...�f..... p i Disno60l Field tSpecify Requirements) .-- - ........................................`:==....._ .--..............._..--................................. ..................... --... ......... r`aw existing and required addition on reverse sidel 1 hereby certify ihat.l have prepared this application and that the work will be done in accordance with Sen Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or icon• sed agents signature certifies the following: °t certify that in the performance of the work for which this permit is issued, t shall not employ any person In such manner as to become sublect to Workman's Compensation laws of California. S. nes! .................. ..................................... Owner BY .......... ...G .. ..... .... ..........._. litle .................... .................................................... l (If of r than owned . 3 FOR DEPARTMENT USE ONLY .._..... ..... ....................... DAT Ir . . ._.._.`. .: APPLICATION ACCEPTED BY .. µ...T- - DATE>.:.....................-.. .. BUILDING PERMIT ISSUED . :........ '. ....... .... .........:........ ADDITIONAL COMMENTS ........... ................. ..... ..........•-•.........................--•-•- •---- ----................•...... ' ._._.............. ..�:.. ... 0 F . ....... - .._........ ................................Date -- �........... ... f=inal Inspection by r 8�71� EH 13 2h 1-6F1 Rev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT �