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FOR OFFICE USE: SANITATION PFRMIAPPLICATION FOR �' Permit No. .:.73^. ., (Complete in Triplicate) ......................................... ._. - pate Issued .�:�`!L.7... ........................................................ This Permit Expires 1 Year From Date issued { Application 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: JOB ADDRESS/LOCATION .._ .�.. �''="��.....................•----................................CENSUS TRACT ---------------_----..._ u u n Owner's Name 1.. ............ ....•---••---- ....................------------•---...... .....--...............Phone ..:1t?l._� �•-t...._.... Address . . ......_ .................... .................. City ----------------------------------- ..... Contractor's Name ------ ..License # _-- - Phone .......----_--- ........... Installation will serve: Residence A artment HousCommercial Trailer Court ❑ e Motel ❑ Other ............_................... .......... Number of living units:.......... Number of bedrooms :3........Garbage Grinder ........ . Lot Size ......... a Water Supply: Public System and name .._.. � ._. .. _-------------------------------------------------------Private ❑ Character of sail to a depth of 3 feet: Sand FaSilt❑ Clay ❑ Peat❑ Sandy Loam ❑ Cly Loam ❑ Hardpan ❑ Adobe 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.) f NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK I j Size.......---------_-------__.......-........... Liquid Depth .--....................... Capacity .. . __.. Type ------ Material.............. ....... No. Compartments __......_...... ...... Distance to nearest: Well --------- •------Foundation .... -------........ Prop. Line ...................._ LEACHING LINE ( ] 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-C] li Water Table Depth -- ---Rock Size ........ ...... ....... ........ Distance to nearest: Well ----------------_-..............I-...__Foundation ........__........ Prop. line ...................... REPAI ADDITION Prev. Sanitation Permit# -------------- ------------ .... Date ----...__...___._....._ ---.) Septic pecify Requirements) Disposal Field (Specify Requirem nts) -----_----------------------- ----- n --- - . ►-.... . � 6 �!3!.. .- - --------- -- -------------- • ...............- ......... ....... ... ......... ...... .......... (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 Son Joaquin County Ordinances, State laws, and Rules and Regulations of the San Joaquin Local Wealth District. home owner or lice:~ sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to becort/►eubje Work n's Com nsation laws of California." Signed�. - ..... ...... Owner By ........... ................. Title . .... -.. .. ........ ...............------.... (If other than owner) I FOR DEPARTMENT USE ONLY DATE .. APPLICATION ACCEPTED BY .�. _1-11 ... ......... . . .. .. ._. .......--•-------"------- BUILDING PERMIT ISSUED ..... .... ... . DATE ..-.-..-.. ADDITIONAL COMMENTS .......... --- .........__.1.......... .......................I—_. ............................ --------------- ------_....---.. ...... • -------- ----------- ................. ...................... ...... Date .............................. Final Inspection b `�3 SAN JOAQUIN LOCAL HEALTH DISTRICT 7/723 .14