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FOR. OFFICE USE: pppL{CAT1bIV 1=0R SANITATION PERMIT Permit No. --__ {complete in Triplicate) } - Date Issued --- ----- ------ --- - ----- ------------------------------------ This Permit Expires 1 Year From Date issue Fk Application is hereby made to the San Joaquin Local�tlHealth District for Ordinance permit t and existing Ruo construct and lesandRegulations.e. worherein pp described. This application is made in compliance �' 45 - CENSUS TRACT ----------- -------------- ------------- JOB,•ADDRESS/LOCATION -d -------phone ------------------------------------ Owner's Name s _ . -:- --- - - __ CitYT:,7 ---------- As ----------------------1Phone _ l 52 License # Contractor's Name ----------- �� "--_ h i Installation will serve: Residence ❑ Apartment HouseCommercial ❑Trailer Court ,❑ Motel ❑Other ----------------- -------------------------- Number of living units: "T'Number of bedrooms --_----Oarbage Grinder /V4--- Lot Size ".--- --- ------Private ❑ Public S stern and name ---__- --- Sandy Loam ❑ y' Water Supply: Y Silt❑ Clay ❑ Peat❑ Cla Loam ❑ i. Character of soil to a depth of 3 feet: Sand Hardpan ❑ Adobe Fill Material ..... ------ If Yes,type -------------------- ------- ildings, etc. must be placed on reverse side.) (Plot plan, showing size of lot, location of system in relation to wells, bu NEW INSTALLATION: 1No septic flank or seepage pit permitted if public sewer is available within 200 feet,) - Liquid Depth ---------------------.----- � PACKAGE TREATMENT [ ] SEPTIC TANK i[ ] o Size---------------------------- ------ ------------ Capacity - Type -------------------- Material------------- ------ No. Compartments ------•-=--------= 0 Distance to nearest: Well ------------------------------------ Foundation -----------------------Prop. Line ------------•_-------- �--- - -- - ---- Total Length ---- -------------•--------- LEACHING LINE [ } No. of Lines --__--- - ---------------- Length of each line----------- 'D' Box ------ ----- Type Filter Material ---------------------Depth Filter Material ---------------------------•---- -------------- Property.Line --------- ----=-... I Distance to nearest: Well ------------------------- Foundation -------------- Depth -- ----- ------- Number ------------------ Rock Filled Yes ❑ No I❑ SEEP PIT [ 3 p ----- - ---------- Diameter RockSize ------------ ------ ----- - - Water Table Depth ------------------------------------------------------Foundation -------------------- p• Pro Line ---•------------------ Distance to nearest: a ----- - -------- . _ ` Date ----------------------------------1 REPAIR/ADDITION(Prev. Sanitation Permit# -------- --------�---► --- - ;--------------------------------------- -----•------------- - _ Septic Tank (Specify Requirements) - -- ----- ��( / x� <_ � ----�� 5 -1�-•-------- ecif Require Disposal Field (Specify y q ----------- l -------- ---- ------ ---•-- i {Draw existing and required addition on reverse si del 1 hereby certify that 1 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. Horne owner or lieen- sed agents signature certifies the following: "I certify that in the performance of the work fon,ate this aE California." issued, I shall not employ any person 9n such manner as to become subject to Workman's Compensat Owner Signed -- -`=----- --- - -- /an ---- --- 1 ( - ------------------- Title ----------------------------------- -4J ----------------------------------- (if otherw er) FOR .DEPARTMENT USE ONLY DATE ------------------- _ " ------------------------------------------------ ---- DATE ------------•-------- APPLICATION ACCEPTED 13Y ____ -"'--- - __ BUILDING PERMIT ISSUED --------------------------------- --- ------" ADDITIONALCOMMENTS ------------------------------------------------------------------------------------------------------------------------------ - _ - ----------------- ----------- -- -------- ----Date-- "" --f ------ ---- ----- J ------------------------------------ _ - -------------- - Finallnspection y: SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6B Rev. 5M