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FOR OFFICE USE. APPLICATION FOeSANITATION PERMIT ------------------------------------------ (Complete in Triplicate) Permit No: ----------•----------------------------------------------- ------- ------------------------------------- -- _ ' This Permit Expires l 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 compliance with County OrdinaAce No. 549 and existing Rules and Regulations: Y JOB ADDRESS/LOCATION . � 1 ------ ----------!::284 ----------- --- -----CENSUS TRACT --------------•----- FOwner's Name --------------- --------- -- ------- T - ------- ------- ------ ------ ------Phone Address ------------------------------ --- -------e------------ City ---- - ------------------------------------------- Contractor's Name ------------ t t7-------------------License # AGj��----- Phone ---T� � Installation will serve: ResidenceApartment House E] Commercial ❑Trailer Court E-1Mote ❑Other -------------------------------------------- Number of living units,____---- Number of bedrooms _..__Garbage Grinder ------------ Lot Size -- ______._. Water Supply: Public System and name -------------------------------- ------------- ` Private --------------------------------- -- ---------------------P ' to Character of soil to a depth of 3 feet: Sand'❑ Silt 0 Clay E] peat❑ Sandy Loam U Clay, lay Loam Hardpan ❑ Adobe Fill Material ______.__.__ if es;.type ________________________-- ' r. (Plot plan, showing size of lot, location of system in relationrto wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No`se'ptic tank or seepage pit permittTd"if public sewer is available within 200 feet,) PACKAGE TREATMENT Capacity [ ] Type :_ Material Liquid Depth - `) SEPTIC TANK' Size----------------------- -------------- i �. � ' - Yp - •- ___--Foundation No., ,Compartments -----------------•-•-- Distance to nearest: Well ----- --------------------- --------I'-----'`�'rProp. Line --------------- LEACHING LINE No. of Lines ------------------------ Length of each line---------------------------=„Total Length-"'.____------'�s= --.....__-- � 'D' Box ------------ Type Filter Mcterial ---------------------Depth Filter Material -------------------- ¢ - r --------- -,A •k`y� F{Y K _--- _ Distance to nearest: Well ____ F Foundation ____________________ "_`Pro-Property-------- -- - per Line. _---------•-------•----- SEEPAGE PIT ( ] Depth''. _ ____ Diameter ----------N--___ Number _._______-_J-_____________ Rock Filled Yes ❑ No i❑ _ . ater Table beptEt `--`--=-=--=-------- -----=--•-----------------Rock Size ------------=-= ---------•-- Distance to nearest: Well ----------------------------------------Foundation ------ Prop. Line ------------------- -- REPAIR/ADDITION(Prev. Sanitation Permit# ___ _ f__-- Date Septic Tank(Specify Requirements) _ _____._ _ _ ----C st,cr-� --t c� � r�_mak _.,� C1 p -- - .Disposal Field (Specify Requirements) ----- .-,pGI__i _lam- -Zs----- i� -- _I - -------------------------------------------------------- ----- -- i e 1 --- ------ - ---�-- _ y �--- --------f -- - -- ------------------------------------------------------------------------. (Draw existing and required addifion on reverse side) 1s 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, 04'Rules and Regulations of'the-San-Joaquin Local--Health-District. Home owner or llcen- sed agents signature certifies the following:., , ', ; r_ 'a ` . "I 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 become subject to Workman's Compensation laws of'Cctlifornia.v "µr' ,_ . Signed -- ---------------- -Owner By, --------- Title ti� -- _ � (If other owner] ----------------------------------------- f 7 i 1 ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ - _---- - 1 -� ------ -------------------------------- DATE .. --- BUILDING PERMIT ISSUED --------DATE . ,ADDITIONAL COM TS ------ --- - ------------ ---------------------- - -- r� -$"- - - - -------------- --------------- ------------------------------ ` - ----------------- - --- Final Inspection by:------------ ---- -----Date --- -- . -- ----- SAN JOAQUIN LOCAs. HEALTH DISTRICT � f E. H. 9 1-'b8 Rev. 5M f�