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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .Zr 1Complete In Triplicate! ........... ........... .....""i... '. .... _...... This Permit Expires t Year From Date Issued 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 c pli nce Cou Or in No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION -.. f�� ..... Q. � ! '. .CENSUS TRACT .......................... Owner's Name ... ._. . .. ........ ......... . /`y� -� Mone Address . _ _. ._ City ............ .. ....... ..................................... Contractor's Name N` a---. � ...License ........................ Mone .-.pie :. Installation will serve: Residence 2f Aportment House 0 Commercial❑Trailer Court ❑ Motel❑Other.......................................... Number of living units:..... .... Number of bedrooms .27::::...Gar Grinder ............ Lot Size - �..�. -. �./.. Water Supply: Public System and name ..............................._.......... �.....1�(!!a'Ctr 1. ...............Private❑ Character of soil to a depth of 3 feet: Sand n Silt❑ Clay ❑ Peat Sandy Loom 0 Clay Loam Hardpan❑ Adobe Fill Material ............If yes,type............... ............ JPlot pian, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.{ NEW INSTALLATION: JNo septic tank or seepage pit permitted if public sewer is available within 204 feet,! 'A PACKAGE TREATMENT ( ] SEPTIC TANK f ] Size................................................ Liquid Depth .......................... 6 Capacity -------------------- Type .................... Material...................... No. Compartments ....V% Distance to nearest: Well ......Foundation ...................... Prop. Line ...................... LEACHING LINE ( j No. of lines -- Length of each line............................ Total Length ............................. D' Box Type Filter Materia) ....................Depth Filter Material ............................................�. Distance to nearest, Well Foundation ........................ Property Line ........................ SEEPAGE PIT ( J Depth .................... Diameter ................ Number ............................ Rock Filled Yes ❑ No 0 Water Table Depth ................................................Rock Size ................................ Distance to nearest: Well ..............Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prov. Sanitation Permit ............ ..•--•------.. ....... Date ._. ........... Septic Tank (Specify Requirements) ....... . ..............—-.........__ V Disposal Field (Specify Requirements) •--- -•---- --•---------------•-------• ........................ (Draw existing and required addi on verse 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. Hem* owner or Ikon- sed agents signature certifies the following: "I certify that in the perfo n o of the work for w t permit is issued, I shalt not employ any person in such manner as to becomes iect�tg W an's Cq(mp so' n ws of tifornia." �(,�/ Signed . ----••`--------- ---- ------ --- . . •• •--•_.. ...... `.. Elwa�er BY -----------------------------------------I---------- ...... Title :_......_._..._........_ Jif other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . .. `-----....---•--------•--------- ...............................------------------------------. DATE ------- ...... BUILDING PERMIT ISSUED - -------- --------: ---- -p ._:-- --.-. DAT - ADDITIONAL COMMENTS . ............. .' P,S._ --------------------------------------------•-- ........._-.......... ..................... ................._................... ----- ••-"-----•-----. ..---.._I..........-•---........_ ..................... -------- -- P.._........ - .... - p Y ----------------------------------------------- ......................._._Date �.� I ' - ---- -....... ... - '.-............... Final Inspection b : .._. _ .. ... EH 13 24 1-613 Rev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M