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WR OFFICE USE: / APPLICATION FOR SANITATION PERMIT V/ lCompleh In Triplicate) Permit No. . $ $�._.... ....................4-.l. ..... .................... This Permit Expires 1 Year hem DateIssuW Date Application is hereby made to the San Joaquin Local Health District for a permit to construct and instal) the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS OCA,LIION ...A6. ..........................CENSUS TRACT .......................... ' 1/._.., Owner's Name ... ..._./ �c .............................. .................Phone ?: _. r. -. ._ Address . . ._.,�. Zo ! �ocL� AES .,..... ....... ..` ..City ... 4Ja .. .. f Contractor's Name . S. ._... v-...5..a:,...... ..licensed_.-... Phone ��E,S .......... Installation will serve: Residence wipartment so[03 Commemial❑Trailer Court ❑ G Motel❑Other � "t'�...................... Number of living units—... ._.. Number of rooms . ., . ... Garbage Grinder . Lot Size / ,X `? .,.............. Water Supply: Public System and name i/_.. k.,................................................................................................ tx' Character of soil to a depth of 3 feet: Sand 0 Slit❑ Clay ❑ Peat❑ Sandy Loaw40 Clay Loam� "w Hardpan❑ Adobe Fill Material ........if yes,type............... ............ :t` (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must4w-placed on reverse side.) ._. NEW INSTAII TION: (No septic tank or seepage pit permitted if public sewer is available within 200 feat,► O` PACKAGE TREA�AAft j.] 9EI TANK{ J Size.............................................. Liquid Depth .......................... Capacity Type -------------------- Material...................... No. Compartments ...................... Distance to nearest: Well ...............Foundation ...................... Prop. Line ...................... LEACHING LINE ( J No. of Lines ........................ Length of eadi-11we.............................Total Length ............................ 4 'D' Bax .......... . Type Filter Material . ...%.. ::'..,...Depth °Miter Material ........................................:... Distance to nearest, Well ........................ Foundation,*..:,,..................... Property Line ........................ SEEPAGE PIT [ j Depth .................... Diameter ................ Number ............................. Rock Filled Yes ❑ No O WaterTable Depth -•--••.......................•.........---•.....Rock Size .............................. Distance to nearest: Well _____•..................................Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prov. Sanitation Permit ...........................................iiDate .................:'I.............I Septic Tank (Specify Requirements) _...,1.1,c5. //__ .....Al�1........ ..................... Disposal Field cif P ( Y $gsluiremer�ts) ¢.ct t....•• 1i�1:.: � _...�'......,., .,X/.. !��.._ .v. . ................... ------------------..................................... _ -_ ._..: -•-----•--- .,_.... ............................ --..•.....................-••-••--•...... ........................ Y .......................................•..................................... _........................................ ......._.._.._.__.......__........... .:�p...................._............................._............._............................. Draw existing and required addition on reverse side) 1 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 ti l San Joaquin Local Head District. Hem* owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this porthi ii Issued, I shall not employ any person in such manner as to become sub ec Workman's Compensation laws of California." Signed .... . ... .. ......... --------- Owner By .......... •Title (If other tha her) R DEP MENT uS ONLY APPLICATION ACCEPTED BY ----- . . ......... DATE ------ BUILDING PERMIT ISSUED ---------- -...................... ......... ........:..,_...._...----......_....;.....DATE / w• -•---•--- ADDITIONALCOMMENTS ........--•........ ..................... ................... ... ..... .._..... .. ................. -----... ._. ----------------- --- ----•----------....._.._......... ----•- • .......... ............................. ............. ......... Final inspection by: -------.. .............. .................Date .. .l ... 1 Elf 13 2h 1-68 Rev. 94 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M