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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --- /1 2's-1---------- (Complete in Triplicate) Permit No: ------ 3� '-------------- �i� - Date Issued _Gr2.v ? 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 w' h County Ordinance No. 549 nd existing Rules and Regulations: n JOB ADDRESS/LOC ION .__ --- .- -__ _ ------ -- ....-CENSUS TRACT -------- -- --------- __ III --- - - --Phone ----------------------------------------- ----- Owner's Name A Address ---- -- - ; - ------------------ City -£-T-"------ ------------------------------------------------------ Contractor's Name ---____-- '-- _--- License # --- --- ----- Phone - -- _-- ---- -- Installation will serve: ResidenceApartment House❑ Commercial❑Trailer Court ;0 Motel ❑ Other ------------------------------------------- Ir Number of li'vin'g units:_-------Number of be oms ______Garba a Gri de -.. Lot Size ..__ __-.____ _ ' r i Water Supply. Public System and name ------- 'I-V/ ----- `c ------------- Private E]Character of soil to b depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan E] 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) V PACKAGE TREATMENT J I SEPTI TANK' Size_-: ,1 -- --------- ------- Liquid Depth -------, �- P -----------------= Capacity -�-�_ :_ Type - Material__ ___ _-_______-_ Na. Compartments Distance to nearest: Well __-_____-- Foundation �_______.Prop. Line fr-_/._________ LEACHING LINE No. of Lines ------D,----------- Length of each line----- - - - Total Length /-. -i -------- lft ? J ----- --------•- `U r �r_ e th Filter Material D' Box _-yo-nearest: _ ?Type Filter MaterGal _____--- _ _ -- p f r Distance o nearest: Well -------------------___ Foundation0__�--_--___ -- Property Line. l.- - ii -------- SEEPAGE PIT - [�]` i �! Depth �-1-------- Diameter�3---------- Number _- ----- --- ------- Rack Filled Yes I�` No i❑ T ' ` Water Table Depth ------- Rock Size _--- ---�"-_3-- ------------- ';e7 Distance to nearest: Well -----------' ------.Foundation - -r-_--- Prop. Line _ ----------•-_--- REPAIR/ADDITION(Prev. Sanitation Permit.#------------------ -- -� --- Date ----------------------------------} Septic Tank (Specify`Requirements) ------------------------------------------------------------------------------------------------------------------------------------------ Disposal Field (Specify Requirements) -------- ----------------------------------------------------------------.------------------------ i r A c -- 4 ________________________ fi- t (Dr.aw existing and required addition on reverse side) w 'I I hereby certify that',l 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. Home owner or licen- sed agents signature certifies the following: ' ' " ` '�' i`"Njjll-not employ any person in such manner. "I certify that in the performance of the work for%i ildi't 6�permif` issued, as to become subject-to Workman's Com ensation laws of California." Signed ----------- ------- Owner ?) BY ------------------ ----- - Title -------- ---�_ ------- - ------------------------- (If of ei th owner) PAitTMENT USE ONLY _�. . - DATE _-.----- � I APPLICATION ACCEPE ED BY_�-'---- °- --- - -- -- ------------------ --------------------- �- BUILDING PERMIT ISSUED._-: ------ DATE ---------- ADDITIONAL ---- ^--ADDITIONAL COMMENTS -------- - - ---- - ------- -- - --- ------ --------------------------- ------ ------- ------------------------------------------------------------------ Z � -----------✓-3--rr-- -- ---- ---- -- 10-61k -------Y&O-d------ae_-- - - ----------------------- --- ---- -- --------------- = - ---- -------- - - ---------- --------------------------------------- ------------------------- -------------- - Final Inspection b -------- ------ - ------------------------------------------------Date "' JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'h8 Rev. 5M