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FOR OFFICE USE; APPLICATION FOR SANITATION PERMIT Permit No. ��--3�-- ----------- --------------------------------------------- Complete in Triplicate) 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 desJcribed. This appli ation is.made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LO WI` it .-Co7z!?1 ---p _ rn�/ IZ__ nld_ � 7 ---CENSUS TRACT -------------------- -- Owner's Name �%__}" � � Phone 1�""�� ---------- - f�;- ►y1 ---93---- - ._.. city /?//,I [!l!ti-�' ----------------- --- --------- Phone__�.-,__-_t_- p- Contractor's Name ----- T License # l- ------ Phone O__ - tc_ � �------------ ------------------i will serve: Residence Apartment House❑ Commercial ❑Trailer Court '❑ Motel ❑Other --------------------------------- ------ Number of living units:-----r"----- Number of bedrooms --X-_-__Garba_ge Grinder ------------ Lot Size -------------------------------------------- I` • Water Supply: Public System and name -------- ---------------------------- ------------------------------------------- -----------------Private ❑ L Character of soil to a depth of 3 feet: Sand'[ Silt❑ Clay ❑ Peat E] Sandy Loam [] Clay Loam:❑ ` Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type ---------------------"_----- ++I I' (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 !thin 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK'[ ] Size---------------- -------------------------- --- Liquid Depth ------ -,•--- Capacity -------------------- Type -------------------- Mate al--------------------- No. Compartments ------ ---••- Distance to nearest: Well -------------------------- ---------Foundatio --- ---------- Prop. Line ---------- LEACHING LINE [ ] No. of Lines ------------------------ Length of ch line---------- --------- ------ Total Length ------------------------- 'D' ----------.------------'D' Box .----------- Type Filter Material - ------------------Dep Filter Material ------------------------------------•- N, Distance to nearest: Well --------------- -------- Foundati ------------------------ Property Line. ---------------------- SEEPAGE PIT [ ] Depth -------------------- Diameter - ------------- Num r --------------------------- Rock Filled Yes ❑ No C.- Water Water Table Depth ---------------- ------------------------ ------Rock Size ---------------------------•---- [tel Distance to nearest: Well --- ------ ---------------- ----------Foundation --------------------- Prop. Line ------------- ---- " 1f REPAIR/ADDITION(Prev. Sanitation Permit# ------ - --------------------- ----------- Date _-__----_-------------------------) f Septic Tank (Specify Requirements) ------------- ---------------------------- ---------------------------- Disposal Fie (S ecy#y Requi ments) ------ -_"-- --------- --- ------------------ --- ----- - ------------- �1----- - /1 _ T-29C' ffC �J� ----------------------------------------------------------- - -- - - ----- ---------------=------- ------------------------------------------------------------------------ )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: "1 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 becomeWsubjectorkm 's Compensation laws of California."Signed ----- --- ---- � OwnerBY -- ----------- Title ------------------------------------------------------------------------ (If other than owner) �- FOR DEPARTMENT USE ONLY p APPLICATION ACCEPTED BY ----- 1_-_l -------- DATE r�l = -------------------------------------------------------- --------- BUILDING PERMIT ISSUED ---------------------------- ------------- DATE ADDITIONAL COMMENTS ------------ -------------------------------------------- ------ ---- - ------ ----- -- - - &--&- --------------------------------------------- --------------- ----- ----- -------- -------------------------------------------------------------- Final Inspection • --- -------Date --- --- -- " SAN JOAQUIN LOCAL HEALTH DISTRICT 4 F W 4 1-'AR Rav SM