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FOR OFFICE USE: APPLICATION Folt SANITATION PERMIT Permit W. S n lG►rnpl In Tr{pHcate! . ..7.............. .... ....................................................... ` (/ This PermltExptres t Year From Daft I ved 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 Ordinoqco NO. 549 and existing Rules and Regulotionsc JOB ADDRESS/LOCATION -:..._. j ... , ..... ,! .. .............cENstJS TRACT .......................... Owner's Name l��C.`j..t,-c �� v- Phone .................................... Address .. - c .�. Y .._ 'sf........................ WA Contractor's Name ... .._ .... .................................................License#,9. /?XJ._�j.7..._ Phone .. Installation will serve: Residence L.4Aod-+mit House{_] Commercial[3Trailer Court E] ~. Motel Q Other............................................ Number of living units:.....-....- Number of bedr, s - ........G�a`rb�age Grinder �. Lot Size .�`-•-.��'`�d�..._ ...... Water Supply: Public system and name ..._. �t,.r/l/ ,...W-... '�.. ...........II...............................Private Q. Character of soil to a depth of 3 feel. Sand Q Silt d Clay peat© Sandy Loam.fl Clay Loam❑ Hardpan 0 Adobe Fill M61wIal-:1:/d.if yes,type............... ............ (Plot plan, showing size of lot, location of system in elation to wells, buildings, etc. must be placed on reverse skJe.} NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK{ J Sits................... . ......................... Liquid Depth .......................... Capacity -- _.............. Type ................••.. Material...................... No. Compartments ...........'........�" Distance to nearest: Well ....................................Foundation ...................... Prop. Lime ......................"IN LEACHING LINE [ I No. of Lines ........................ Length of each line............................ Total Long. ............................M 'D' Box .......__ Type filter Material ...........Depth .Filter Material .............................................P Distance to nearest; Well .......................1. Foundation ......................'. Property Line ........................ SEEPAGE PIT [ ) Depth -------------------- diameter ................ Number ............................ Rock Filled Yes [] No Q Water Table Depth ....................... ._......Rack Size Distance to nearest: Well .........................................Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ....... ................................... Date .............................. Septic Tank (Specify Requirements) ._................. .... ............. ....... ... aFe ....... ......'.� _......—_... _.. ......:__ Disposal i !d (Specify Requirements) .. .. 2 -• .-. (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work wRi be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local HooW,Disidd.Hoare owner or liaw sed agents signature certifies the following. "1 certify that in the performance of the work for which this permit is Issued, I shah not empioy any person in such moaner as to become subject to Workman's Compensation laws of California." Signed..... •. Owner BY .. ---"--"-•----- .................. Title .... ...... er than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ .................. .. . _... DATE "•"""---•--- BUILDING PERMIT ISSUED . .................................................................................................. DATE ., ................................... ADDITIONAL COMMENTS ... .......................... ..-""---• _._............:. - . •- ----------- ....------- s' --.. .......... ----.. ,: Final Inspection by: .............................................. Date ----- EH '`�' ..��:'...T EH 13 2h 1--613 Rev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M