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FOR OFFICE USE: Y ---- APPLICATION FOR SANITATION PERMIT Momplete in Triplicate) Permit No. ..................... ~ .... This Permit Expires 1 Year From Date Issued Date Issued ....... J� Application is hereby made to the San Joaquin Local Health D€ 'ct for a permit to construct and Install the work herein described. This application is a in complianncce' with C,4iunt rdinance o. 549 a d existing Rules and Regulations: ._.I[ �5�.5 f�. . ... ..�.... .... ._ L JOB ADDRESS/LOCATION - . . ....- ,, ��. ................CENSUS TRACT ........._................ Owner's Name T�.Q.P�__. .......I............. .....:....... .... one Address ..............:. . - CII /J . . / .... .... .. License .......... Phone�..... .. .. :. , . Contractor's Name .. .... Installation will serve: Residencejg(Apartment House Commercial OTraller Court 0 Motel ❑Other, :-.:. 1 .......................... ��...... Number of livingunits:-../-.--. Number of bedroom ..---- ...Garbage Grinder ............ Lot Size �... .... Water Supply: Public System and name ---------_.................................................................. ----------......................Privateer Character of soli ton depth of 3 feet: Sand❑ Silt o Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ Hardpan❑ ' Adobe-1]_ -Fill Moter€al,7ft=,:"tf-yes;'type--:... ......... - � (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,( to PACKAGE TREATMENT [ ] SEPTIC TANK[ ] Size..................I.....--_...................-- Liquid Depth ------------._...•....••--- N 6 Capacity Type •-•--- Material---------------------- No. Compartments ...................... Distance.to nearest: Well ------..............................Foundation ...................... Prop. Line ........................ LEACHING LINE [ j No. of Lines ........................ Length of each line----------------............. Total Length . 'D' Box ..---_-_ Type Filter Material -.--.-_-------_-Depth Filter Material ................................I.........-- 7 Distance to nearest: Well ------------------------ Foundation ........................ Property Line ........................ (b. SEEPAGE PIT [ ] Depth -------------------- Diameter ................ Number -----------_-------..-.---. Rock Filled Yes ❑ No 0. Water Table Depth -----------..............•-----_------------•.Rock Size ................ --------------- ' Distance to nearest: Well ........................................Foundation --------------..... Prop. line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ...............--------•.------------ ---._. Date ..................................} Septic Tank (Specify Requirements). A .... ....... ........... -p ... ........... .......... .......................................................... .. Disposal Field (Specify Requirements -- . ---- - ...----•• ..._.__... ....................... ......... . ......•.... ------ -- -------------••--------------�� ...... .........--... �4f�� ........................ / ! - (©raw existing and required addition-on reverse 1 hereby certify that 1 have prepared thls application and that the work will be done in accordance with Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the 'San Joaquin Local Health:District. Horne owner or Ilcen- sed agents signature certifies the following: "I certify that in the perfo ante of the w rk far' hick this permit is issued, 1 shall not employ any person in such manner i as to become ble rkman's Camp nsation I ws of California." Signed ----- ? .-- --- ------. . BY - Title -... -n --_-. (!f other than owner) r E FOR DFOARTMENJ USE ONLY f APPLICATION ACCEPTED BY ---- --.... - - DATE 'C^^.', --_------------ ------- BUILDING PERMIT ISSUED --- ----- -- ----------- -- --- - -- ---- DATE ADDITIONAL COMMENTS ------ ............•................. - -... ---------------------------------------------------------...-•------------.-_.--.-.-..------------------------- .-....-..-...-----------------._....--------...------------------------------- ---- ------------ -------------•-•• --------.......-------•-- •-----.........-----•......------.......•----------•----------•---..-- -----------• ---. ------ .......................................... ------------------•-----------•---•• .... .......................--------------------.......................................... . M Final Inspection by: ------------ --- Dale ... '/1'7� EH 13 21a 1-•613 rev. 5m SAN JOAQUIN LOCAL HEALTH STRICT 8/7Ii 3M - 01^, ,