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FOR OFFICE USE: /APPLICATION FOR SANITATION PERMIT Permit No. -------------------------------- (Complete in Triplicate) ------ Date Issued ---- This This Permit Expires 1 Year From Date issued Applicatioh 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: -------CENSUS TRACT -------------------------- JOB ADDRESS/LOCATIO � } � ` ---- Owner's Name -- ---------------- ----------- ------------ n `---------P one -------------------------------•---- Address - ------- ---/_ fps' r ------ - ------ - -- "1't`( City . - a . . �Phcense # - Phone r Contractor's Name __-__ _r^- -- - _ ��---- --- -- --- 1VC Installation will serve: Residence Apartment House E] CommF rcial ❑Trailer Court ;'E]Motel F-1Other _____ Number of living units:------ Number of bedrooms __..Garbage Grinder ------------ Lot Size --" ------- Water Supply: Public System and name --__________----_ ---- " Peat Sand Loam _________________ Private AT - - - ----------------------- Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ ❑ y ❑ Clay Loam Hardpan ❑ Adobe-❑ Fill Material ------ ----- If yes,type -------------`--------------- 1 (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) r p seepage pit permitted if public sewer is available within 200 feet,) NEW INSTALLATION: (No septic tank or �j�/ SEPTIC TANK Size_Y/ _/r `_Y-9� ---- -- Liquid Depth �-------------------• �0 PACKAGE TREATMENT [ [ f ____ Material - ---- No. Compartments ! ..-------- _ Capacity ->7-��a-- -- Type Distance to nearest: Well ----,_-_____ Foundation ---f q------------ Pro Line _.-5-----:.:------ LEACHING LINE [)r No. of Lines -.- .. ------------- Length of each line-___._ -F----- -- -- Total Length -- .------------ -• . �. f4 ._..___ 'D' Box ___:�.___ Type Filter Material �__ _.Depth_.Filter Material -------_______------------------- ------ k Distance to nearest: Well ---------_54------'_ Foundation --------/_0..... ---- Property Line Rock Filled Yes - No SEEPAGE PIT [ ) Depth ---------------- Diameter ---------------m Number ------------ --------- - ❑ iQ T I Water Table Depth -------------------------=--�- -----------------Rock Size -------------------------------- Distance to nearest: Well ---------"----:Wr------- - ----------Foundation ----------------•--- Prop. Line ----------------- --- REPAIR/ADDITION(Prev. Sanitation Permit# -------- ------_------------------- ------ Date ----------------------------------1 . Septic Tank (Specify Requirements) ____________________ ---•-----------------"""""""""""" Disposal Field (Specify Requirements) ------------ ------------------------------------------- ----------------------------------- I ------------ ----------------------- ----------------------------------------------------------------------------------------------------------- --------------------------- ---------------------------- - --- ------------------------------------- ------------------- -Draw existing and required ad -------------- g 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, Slate taws, 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, 1 shall not employ any person in such manner as to become subject to orkman's Compensation laws of California." .Signed -------- ------- �' Owner I ; BY b'- r�� Title 'tl (lf other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------ ---- �-------- ----------------------------- ------------- - -------------- DATE -_a*- --------- ----------------- BUILDING PERMIT ISSUED ------------------------------------------ ----------DATE =ADDITIONAL COMMENTS ---------------------- -----=-------------- - ----- --------- -------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------•---------------------------- -- ------ --- - --- ---------------------------------- ------ ----- -- ------------------------ ----- ------------ ----------- -- -- �Date ----- 'Final Inspection by: SAN JOAQUIN LOCAL HEALTH. DISTRICT e u n 3_'A.Q Dn rAA