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FOR OFFICE USE: L'� J.2. C,cl APPLICATION FOR SANITATION PERMIT �1 - 6 Permit No. .. (Complete in Triplicate -.. ___,f-- Date Issued 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: -.--.. CENSUS TRACT -------------------------- JOB -- JOB ADDRESS/LOCATION �-'�_lE_"- °-�'_!_ .�l�jJ��•.�-�.�.. . - - -- -- ----- ---- --- ------ = � . Cly - Phone .----- Owner's Name - ( - L,� -- --- -y. Cit ire f-- ---------- -----------------------•-"J Address . --- V/� _ �k- > y .-''S- , y,Z_ _.+ - Phone Contractor's Name ___ 's J 1 -may License # / Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court ',[I Motel ❑ Other --- -------- ------------------------- - � Number of living units:--../.. ___ Number of bedrooms -----Garbage Grinder _o W„ - Lot Size _1 Water Supply: Public System and name -------- ---------- -------------•--------- ----------- --------------------- - -----Private Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,] l PACKAGE TREATMENT [ 7 SEPTIC TANK$ Size___ 14 'r �.. - - ------ Liquid Depth - -------------- Capacity IZI(14 "---- Type 1'� - -- - MaterialiCt No. Compartments ____ ----------- �" Prop. Line __ �. i � ---- f� Distance to nearest: Well __ _-�✓.�.------------ Foundafiion _--- - LEACHING LINE X] No. of Lines ,3------------- Length of each line _ 6'---¢ o p Mtal Length --`--(t----- Box _� _ Type Filter Material !6 -Depth Filter Material f. _-- -------------------------------- 'D' �( Y Distance to nearest: Well Ar-10------------- Foundation _ _��- ------ -- Property Line - } SEEPAGE PIT Depth Diameter .-- Number ___ "-------------------- Rock Filled Yes ❑ No i❑ Water Table Depth -- - ------ ----------------------------- -----Rock Size - __--------- - ------------- ` Distance to nearest: Well .--- "---._ --Foundation -- ---- ------ Prop. Line -----_--- ------ REPAIR/ADDITION(Prey. Sanitation Permit'# -------- -------------- - --- ----------- - Date ----------------------------------) Septic Tank (Specify Requirements) ----- -- ----------------------------------------------------- Disposal -------- ----------------------- - Disposal Field (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 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 for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." S;gned -- ------ - ---- ------------- Owner By ...... - Title (if r an wner) FOR DEPARTMENT USE ONLY _ APPLICATION ACCEPTED BY Ems ' (-- ----.-. DATE . .. .. BUILDING PERMIT ISSUED ---- -DATE - ADDITiONAL COMMENTS -- -- ---- ----- --- ----------- ---- -- -- - .. --- -----r - - ---------- Fina - -Date Flnai Inspect;cr: bv: SAN .JOAQUIN LOCAL HEALTH DISTRICT 63 Rev. 5M