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I FOR OFFICE USE: =APPLICATION FOR SANITATION PERMIT ---•---.......-•---•----i................ fCom Permit No. too in Tri lica p t p tel .............. ......b...............111. ................. This Permit Expires 1 Year from pato Issued Date Issued 4./Af%.-2S� 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: J , JOB ADDRESS/LOCATION J._. � ./ f r ' .......CENSUS TRACT .......................... Owner's Name ......... . . . . ......... ............................. .........Phone ..................................... . � - C ..._`.. . .............. ................... . _.. Ci .� ..: Contractor's Name ..... .. .... :. � i ...............License #/ e Installation will serve: Re dence Apo rtment H se Commercia ❑ ❑ l❑Trailer Court j=] Motet jther / Number of living units .... Number of bedrooms Garba a Grinder Lot Size . g :.... ',..� .. ...... Water Supply: Public System and name ...................................Private❑ r Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay [,} Peat❑ Sandy loam [j Clay Loam Hardpan ❑ . Adobe❑ Fill Motetial ............ 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,) PACKAGE: TREATMENT --'SEPTIC TANK I� hze.�., ,.. ..��............................ Liquid Depth - '¢' id D .�. Capacity l�� ..... y .._.. Material. ;.,. ._..:... No. Compartments ✓` ,.:. . .% Distance to nearest: Well ___A40: ....................Foundation ..... .. ......., Prop. Line . ,1Ce.0....... LEACHING LINE j j No. of Lines ,� ....................... Length of each line..._..I.`• V......... Total Length �elo........... 'D' Box .-I....... Type Filter Material I, ..........Depth Fitter. Material .. ........... .... ........ . ° Distance to nearest.• Well ... Foundation Property Lina SEEPS PIT [ } Depth//.ATJ-A, Diameter ................ Number .-. ......... ....... Rock Filled. Yes ❑ No Water Table Depth ..................................................Rock Size .14....................... �. Distance to nearest: Well ---•-••--•..............................Foundation .................... 'Prop. Line ....:....-............. REPAIR/ADDITION{Prey. Sanitation Permit ,. .............................................. Date ...-..............................) Septic Tank (Specify Requirements) ...:......:.. .....................................•.......................................=................ ....... : Disposal Field (Specify Requirements) .........................................................................--------••-•. ..,_.... ----------------------•-••------------------ -------------------------------------------------- -----------------.-.--- --- - ----------•-•-------........-•-•-•---------- ......................----..._............................ (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 the San Joaquin Local Heallh:Distri_ci. Hankie 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 shot( not employ any person In such manner as to become subject to Workman's Compensat n laws of California." Signed -' •--•--------•.................•--- Owner By ........... ------------------ ------------- ------------------••- -------------------------•- Title --------- ----------- (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ......................... ' - •- .-- e-- DATE .. _ --- ----=------ BUILDING PERMIT ISSUED ------------- - -- ------ ................ DATE .... ................... .........I....... ADDITIONAL COMMENTS _. --•---------------------------•-_,_-.- •-------- .......... .................... ....................... ----------------------------- ---------.._._...-..--•--. .................... _._ ....•• ------- ...e" - ------ Final inspection by: -:/_-• Date ... _... ._' - .................. EH IJ 2I� 1-613 l v. SAN JOAQUIN LOCAL HEALTH DISTRICT 1 8/7h 3M T1 ,