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FOR OFFICE USE: ` APPLICATION FOR SANITATION PERMIT_. a Permit No: -- --------------------------------------------------------- - -- -� (Complete in TWieot)6 - ------------------------------ -------- - Date Issued __-�--.��---- This Permit Expires 1 Year From Date Issued - I Application is hereby made to the San Joaquin Local Health District for a permit to construct and install t e..w.o herein described. This application is made in compliance with County Ordinance No 549 and existing RulesU Regulation JOB ADDRESS/LOCATION ._.Y-f�_---- L�� a+`'l7-�J� `" -- CENSUS TRA Owner's Name ------- - ' - --------------------------------=�-------- ---- Phone -------------=•------------•-------- a .01 .!�" �" . City - - Address ----- ��? �3 /a'p ..� ,p - sll�s�r�Z• Phone _l_�` 21616 Contractor's Name " License # . Installation will serve: Residence ❑Apartment House❑ Commercial ❑Trraiiter C=MW Motel ❑ Other ------=------------------------------------- Number of living units:---- Number of bedrooms __An----Garbage Grinder __ __ �__ tot Size —4-441-4 ---`------------- Water Supply: Public System and name ----------------- --•--------------------------------- -------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam;❑ Hardpan ❑ Adobe' Fill Material ------------ If yes, type ---------------------------- t (Plot plan, showing size of lot, location of system in relation to wells, buildings, .etc. must be placed on reverse side.) _1k NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) �i V - ---------- -.------- Liquid Depth �` i PACKAGE TREATMENT [ ] SEPTIC TANK, $1Zee f!/�Vorn-4�- Material 4,917=X-_-_-, No. Compartments _..._____ Capacity/40C?----- Type/ Distance to nearest: Well ------I"- -----------------Foundation ---------- Prop. Line _____-_ - .----. f LEACWING LINE' No. of Lines _ e ` Total Length __%p--------------- ----� ------- -- Length of each line- -��- ---------_ g - �� y 'D' Box IVV-_ Type Filter Material /,!jj^ Aepth Filter Material _ o ---------"------- f � � E Distance to nearest: Well - __�-------- 'A _______ Foundation - �✓--------------- Property Line, ___ __ --------=•--- I /pp i SEEPAGE PIT �Q Depth - �T Diameter �^/p Number _-_---__/------- -------- Rock Filled Yes No arn „ ----- - ---------Rock Size - - -- Water Table Depth ------�`�_---- -----` .l -----�------------- o Foundation _ Pro Line I-T -_________- Distance to nearest: Well -----��-�---------------------- -- -`- Prop. REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------------------------------------ Date ------------------------------------ Septic Tank (Specify Requirements) ------------------- ------------------------------------------------------------------------ ------------------------------------------ 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, and 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 become subject to Workman's Compensation laws of California." Signed ----- ---------------- Owner --- ---------------------------- - - - ------------------------------- ' -------------- Title ---- ��. `------------------------------------- (If of than owner) FOR DEPARTMENT ONLY - APPLICATION ACCEPTED BY - ----- �-- ��-- --------------- ---------------------- ------------ DATE -r7--- -------------- ------� ------ -------- ----------- - -- BUILDING PERMIT ISSUED ------------------------ --------------------------------- _DATE ADDITIONALCOMMENTS ---------------------------- ------------- -------- ------------------------------------------------------------------------------ -------------------------------------------- -------------------•-•---"------------- -------- -- ------- ------------------------------ ------------------ ---- ------------------- _ -- =------- ---------------- ------------------------------------- ---------- ate ---- ---- -- ----------- Final Inspection by: �- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev, 5M. .,► ,