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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ----�--- (Complete in Triplicate) ---------- -------------- --------------- ----- -------- Date Issued -- -- This Permit Expires 1 Year From Date Issued alth District for a permit to construct and install the work herein Application is hereby made to the San Joaquin Local He described. This application is made in compliance ith County Ordinance No. 549 and existing Rules and Regulations: ' JOS ADDRESS/L Tl - --�� .'CENSUS TRACT /f --- . . ---- r'1 Owner's Name --- -- .--- Phone ------- ---------------------------- Address - - ------- --- -- ------------- -------- --- City - ---- --------- -- - -- XI Contractor's Name ----- � J _ --.License # --- - ---- Phone -------------------------•-•-- -- .- - e7---------- ----- - ___ .1" Installation will serve: Residence e-Apartment House❑ Commercial ❑Trailer Court i❑ Motel ❑ Other ----- --------------------------------- Number of living units:------f-_--_ Number of bedrooms-�?------Garbage Grinder _.r=" Lot Size ___ ---------- Water Supply: Public System and iname ----------------------- - Peat Sand Loam ,[] � , Character of soil to a depth of 3 feet: Sand'❑ lit❑ Clay ❑ ❑ y ❑ Clay Loam '[:] e Hardpan Adobe ❑ Fill Material =_-__.._____ If Yes,typ ---------------------------- , (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 [ ] SE k IC TANK'[ ] Size----------------------------------- ----- --.- Liquid Depth ------------.----------- CapacityTYPe -------------------- Material---------------------- No. Compartments -------------- pistancel to nearest: Well ------------------------------------Foundation -.-------------- ----- Prop. Cf Line -----------..-_ LEACHING LINE No. of Lines ------------ Length of each line--------------------- - - Total Length - ----------- •-----I--_-.-.-.• 'D' .- _ g'V Box: _____.__.__ Type Filter Material _______Depth Filter Material ___________ -- - --•------•-•---- Distance to nearest- Well ------------------------ Foundation ------------------------ Property Line .-----------------.----- SEEPAGE PIT [ ] Depth -1-1 Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No 0 ` Water Table Depth - -- ------------------------- Rock Size --------- Distancelto nearest: Well ----------------------------•-----------Foundation -------------------- Prop. Line - .-•------=' 4 REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------------------- -------- Date --------.-------------------------) { I Septic Tank (Specify Requireml6 nts) ----------------- -------- - ----------- ----------------._,<_----- -----------{..--- Disposal Field (Specify Requirements) --------------------------------- - ------------------------- -----------------------------------•--------- - .. �} - ' (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,Iand Rules and Regulations of the San Joaquin Local Health District. Home 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 shall not employ any person in such manner as to b e subject to Workman's Compensation laws of California." Sign --------------------------------- Owner - -- -- ---- -- - ---- --- ------- ----------------------------- • Title __ !- ----------- ---------- ----- -- BYv -- - ------- ----- - (If other than caner) i !1 FOR DEPARTMENT USE ONLY e- D APPLICATION ACCEPTED BY - - --- ----------------------------------- ------------------------------- DATE _7-:'tib_` -_ ---------- rBUILDING PERMIT ISSUED --------;-------- ---------------------------------------------------------- ---------------:--------------DATE --------- -------------------------------- ADDITIONAL COMMENTS -------A ---------------- f r ------------------------------------------------------------ ------------------------------------------------------------------------ ---------------------------------------------- ---------------------------------------------- -------------------------- ---- ----- Date _ ?�f ( -------- Final Inspection by-: --- ._ --- --------•------ -----`------- ---------- - - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'G8 Rev: 5M