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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. -- - --------- --------------=---- ---------- ------------- (Complete in Trip lcate S �� ------------------ ------ �"------------- -------------- Date Issued - - 4 This Permit Expires 1 Year From Date Issue an Joaquin Local Health District for a permit to construct and inst Application is hereby made to the Sall the work herein described. This application is made jp compliance with County Ordinance No. 549 and Rules and Regulations: JOB ADDRESS/LO ATION _ '� "4 CENSUS TRACT I y / Phone -- Owner's Name ! / C-�------ - �-.�-lY-� � --------------------- ------ /I _W/�_ _C°/� City l__:1/ _ p� Address --------------------------------------------------------------- ----------------- -- ------ ---------------------•------- ---- --------------_ d �.rj��` '+P----------- -----------=-------•License #pG - � Phone Contractor's Name __�_- '-- - Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court i❑ Motel ❑ Other ------------------------------------ - b �----- Lot Size - - --Cy��G--`-�----•---- Number of living units:"_-------- Number of bedrooms _ -----Garbage Grinder r - Private ----------------------------------------------------- Water Supply: Public System and name --------------------------------------------------------- Peat�0---- Sand Loam ❑ Clay Loam.1] . Character of soil to a depth of 3 feet: Sand'. Silt❑ � Clay ❑ Y Hardpan ❑ Adobe ❑ Fill Material If yes, type ---------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) V NEW INSTALLATION: (No septic tank or seep pit permitted if �puublic sewer is available within 200 feet,) L PACKAGE TREATMENT ] ] SEPTIC TANK' Size - -- �J------ ----- Liquid Depth ��------------- A Material-- e--- • Compartments _S -------- j Capacity f�4---- Type /'^ — D' Foundation ------ Prop. Line ---6--------------- D- tante to nearest: Well ---�0--------- / �. Length of each line ------ c�-------.-- Total Length `S- LEACHING LINE No. of Lines ____ ._"_- � O '�-_-Depth Filter Material _---,1-I•-s--------------- 'D' Box ---- ------- Type Filter Material- _ ----.----- I Distance to nearest: Well "_ -___----- Foundation _-__1------------- Property Line -s�---------------•--- 4 SEEPAGE PIT [ ] Depth -------------------- Diameter l---------- Number ------------------------ - Rock Filled Yes.❑ No 0 f Water Table De th __ Rock Size ------------ ----- - rr ---------------- -- ---------- - 1 ------Foundation ---- --------- Prop. Line Distance to nea . t: Well ____________ _____________"_--- IDate --------------------- ------------) � REPAIR/ADDITION(Prev. Sanitation Perm t# -------------------------------------------- --------- ---- Septic Tank (Specify Requirements) -- --- ---R -pj-l'z_=_ -----"5a-PT1 Disposal Field {Specify Requirements) ----- -- ---------- ---- - i ------------"----------------- _. -- ----------- -- -------------------'------------------------------------------------------ -- (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 beco subject to Workman's Compensation laws of California." Signed - ---------- / Owner t -- ----- -------------- � ------------- (If --- --------- - Title ------ -- ------- - -------- -------- -------- --------- ------ ' ------------ (If other than owner r FOR .DEPARTMENT USE ONLY �p -z�-�------------ t\` -------------------------------------------------------------- DATE ----�----------- APPLICATION ACCEPTED BY _"'-. --.[- - - BUILDING PERMIT ISSUED ---------------------------- - - - - ---------- --------- --�- ---------DATE ------------------------------------------- BUILDING -------- ---•---------------------- ----- ADDITIONAL COMMENTS - - ------------- ------------- ------------------- ----------- ------------------ --------- ------- --- - -- - ----------------------- -- _ ------ - ------------------ - - ------- ----- -- --- -- ---------- ------------------ ---------------- ----- --------- - Final Inspection " - -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT t E. H. 9 1-'b8 Rev. 5M