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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ................................ Permit No. 1Camplete in Triplicate) ......Date Issued_s...s . �� .......................... 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 County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .. ._. ��`��° � '�.-�--.. ...�.. F'��... . ...CENSUS TRACT ...... Owner's Name j.G`` ` ' ':.................................................................... .....Phone ..J ..:;::�?-`- , ,�,z_ Address _ ? �` ...................... ... '&?-�'tc_�•: .... City .................. ..... . Contractor's Name ........ .`'............... ...License # ........................ Phone ....... -_--_-------_--- Installation will serve: Residence[Apartment House Commercial ❑Trailer Court 0 Motel ❑Other............................................ Number of living units:--. ..... Number of bedrooms ............Garbage Grinder .....::..:.. Lot Size ....... ................................ Water Supply: Public System and name ------------------*....... ................Private Q- Character of soil to a depth of 3 fent: Sand U31 Silt❑ Clay ❑ Peat❑ Sandy Loam 0- Clay Loam ❑ 9 Hardpan a` Adobe ❑ Fill Material ............If yes,type•.............. ............ (Piot 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,) [�7 I l c7.� ��r G t�!✓ Liquid Depth .......................... PACKAGE TREATMENT SEPTIC TANK Size....................................... Y a Capacity ---- --------- --••• Type .................... Material.. :_ No. Compartments ......%i::.......... Distance to nearest: Well ... .. .. ................Foundation ............... Prop. Line .... 3."...`.'..-.... LEACHING UNE [ ] No. of Lines .....3................ Length of each line...e ....... Total Length 71.7 ................. ©' Box -•---- ..... Type Filter Material ---;-:.....MrAepth Filter Material ------ ................................. r5� ` S.C. i� .. Distance to nearest: Well .....�................. Foundation ........ ... ...._... Property Line .-.. ••.-•=.•-•-•.•.••-. SEEPAGE PIT [ ) ¢ Depth -------------------- Diameter ................ Number ............................ Rock Filled Yes ❑ No 0 WaterTable Depth ................................................Rock Size ................................ Distance to nearest: Well ........................................Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ........_...•..-• ................ SepticTank (Specify Requirements) ------------------ --------- ................................................,.............................................................. Disposal Field (Specify Requirements) ------.--- ---------------- ------------- ------------------ --------------- ------- -----------......-----------------•-----------•----------•---•-----------------...._...._...•...----------................._.._............. ------------- ------------ ............................_........................ .......................... ........................................ (Draw existing and required addition on reverse side) I 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. Home owner or licen- sed agents signature certifies the following: "1 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 sect to Workman's Com , satton taws of California." .1.�.-1.1_ " rj a L Owner Signed -- -=--------•. .................................. . BY ----- --------------................. Title ._----------- - - -------- ----- - ------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _.. °..` ._'....:_:P_ -.---. --.___._.. DATE � � --- - -------------------------------------- BUILDING PERMIT ISSUED .... ------------------------- --- --•-------•----•------------------------------- -----......---DATE - -- -- -------------_--------- ------ ADDITIONALCOMMENTS .----------._...................•.....-----....._--•---------------. ------ -----•--_.-.- ......... ..........----- ... ....._............................. -------- -----_---------------......--_- ... .....---•---------------___---------------------- ----..------------- _. .----------.---------- .......... -_-_-------------------- -------------- Final Inspection b Dake .. �. -.�._.'.. . ............... ..- ...--....-.................... EH 13 24 1-68 Rev. jM SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M