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FOR 4F9ICE USE: +�u APPLICATION FOR SANITATION PERMIT f 6 Permit No. ..7.... p (Complete in Triplicate) ... ............... ....•--.........-•--.... 3S 7 _ bate issued ......�....._..:... This Permit Expires 1 Year From Date Issued Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with Co my Ordinance No. 549 and existing Rules and Regulations: f ._._ F?` - ..............CENSUS TRACT JOB ADDRESS/LO ON ...�. ,r_,.. Owner's Name ...._ � .. ..L...�... Phone ._...... __. Address ................. .... • .. .... .. Ci ............. Contractor's Name ..... -• .. . . ---•- --._. n..License # .1 .. Installation will serve: Residence [] Apartment House 0 Cotr mercial [)Trailer Court 0 Motel.0 Other'.. Number of living units:--_._--- ...... - Number of bedrooms -----•--:--Garbage Grinder ...... Lot Size ........:......... ........ I Water Supply: Public System and name -............................... ..........-----------_---.----- -------......................................Private Zr, Character of soil to a depth of 3 feet: Sand_0-Silt Clay ❑ Peat Sandy Loam [-I Clay Loam ❑ I Hardpan E] Adobe C] 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.) V NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) i PACKAGE TREATMENT ( ] SEwPTIC TANK TA/ Size.a."./-_1_... .X_A............. Liquid Depth ..�(.................... Capacity X_- --. Material--- .. No. Compartments ............ ._. ?O-- - YP Distance to nearest: Well .__... v.....__.__._•-••------Foundation ..__�.�1_.......__.. Prop. Line -__`r---------------- LEACHING LINE (),/ No. of Lines --------- ............. Length of each line---------------_. ......... Total Length ...5"u..._•--......._. JIA 'D' Sox ........ Type Filter Material ....Depth Filter Material ....--p............... Distance to nearest: Well .......S-........... Foundation .....1.P............. Property Line ._. �................ SEEPAGE PIT E ), Depth .................... Diameter .--............. Number ...__.___._.....--------_--- Rock Filled Yes ❑ No (:I �I Water Table Depth ---------.--_---_....................•.•••••.Rock Size ..................-------•-•---- Distance to nearest: Well ....................Foundation ._.-_-._ ......... Prop. Line ....................... r REPAIR/ADDITION{Prev. Sanitation Permit# ............... ---•----- ..........- Date ..................................1 --- ................................ ........------------..._....----•---•-•-••....._..... Septic Tank (Specify Requirements) -•................... 4 DisposalField (Specify Requirements) ......... ................. -•---------......------------_----_-------••---- •----•-------------........----------------_-- ----------------------------------•--•-------------------------------------------- - ---------------------------------------••..----------....------------... -. ---------------•--• ----------------•-•------------------ (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 k 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 forwhich this permit is issued, I shall not employ any person in such manner asbecome subject to Work n's Compensation laws of California." k Signed ----------•------_------ -- -- --------------- ........-------_. Owner --- r By . . Title ._ .c -'_...... ...-. s (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED dY ., '?'" ril,�`-• DATE .. �2- '/ ---------------- ..-•------------------ ...__......._ BUILDING PERMIT ISSUED ............................ - ---._.............DATE __.....__........ ADDITIONAL COMMENTS ...... ......................................................................... .....................................---------- •................---------•--.--..........•-------......_...............------..... .........................,........................................ . - ` ................... ` Final Inspection by: ..Date-:'...................._......... .......... SAN JOAQUIN LOCAL' HEALTH DISTRICT W.,- r 7/723 M