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I rvx vrrrLz Me . APPLICATION FOR SANITATION PERMIT t. e:. `..... (Complete 1n Triplicate)` Permit ................... ................ . .... . This permit Expires T Year from Date Issued Date Issued ............,....� i Application is hereby evade 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 Ordinance No. 549 and existing Rules and Regulationse JOB ADDRESS/LOCATION .................. Owner CENSUS TRACT . .... .... 's Name . . ... .. .. .. ... ......... .. . Address .......... �' ., :Phone ... .................:.. Contractor's Name .' - . ......... ,. ,. . .. _ ..................................License #X.9a.71... Phone . Installation will serve: Residence❑ rtment Ouse❑ C9mm al-WTraller Court (3ther_ t ..--?97 Number of living units:............ Number of bedrooms .....Garbage Grinder Size f, Water Sy d name ..:...� ' . .... .... ..... Character Supply, Public stem an ... ........... ..�.---•..... A �� 1 110114 Char o &oil.to a depth of 3 feet: Sand Silt Cla t C] y ❑ - Peat❑ Sandy Loam ❑.. day Loam ❑ Hardpan p Adobe❑ Fill Material ............If yes type............... ............ !Plot plan, showing size of lot, location of system M relation to wells, buildings, etc. must be placed on reverse side.~ NEW INSTALLATIONS (No septic tank or seepage pit permitted If.public sewer is available within 200 fest,! PACKAGE TREATMENT [ ] SEPTIC TANK{ Size............... � - � ................................. Liquid 'Depth ...............,.......... Capacity .................... Type .................... Material...................... No. 'Compartments ................ Distance to nearest, Well ....................................Foundation ............. ..... LEACHING LINE ......... Prop. Line .................... f No. of Lines .............. . Length Of each line............................ Total Length ............................ V. Box ............ Type Filter Material ....................Depth Filter Material ............................. -' .'Distance to nearest: Well ........................ Foundation ........................ SEEPAGE PIT Property Line ................ F f ) Depth ............... Diameter ................ Number ............................ Rock Filled Yes ❑ No ; Water Table Depth4W M ...........................................Rock Size r Distance to nearest, Well ................................ .Foundation .................... . .. .. k REPA1It/ADDITIO �� ... ............ .... Prop. Une --•--••--.......... N(Prev. Sanitation Permit .,�!. :-......... ......... Date Septic Tank JSpeclfy Requirements) •• I . :.......a...... :.�� ......: ................ � Disposal Field )Specify.Requirements) ........ `.......... ............ -- y --•........................................................................... .................................................................................................................................................................................... . . (Draw existing and required addition On reverse sicfej.. .................... ... .. .. C -I hereby certify that 1 have Prepared thls-application and that the work will be clone in accordance with Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or ilcen- 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 r as to becom ub)ect to Work a 's C pensatl laws off California." P Y an Y Person In such mannan Signed .... ........................... Owner e; By ..... ... .... . ..........................:_ Sitle --. y IN other han o ed ' R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_.. BUILDING P : ... . ............................................................................... DATE ..: :::�� .. PERMIT ISSUED _' — I ADDITI�,I COMMENTS .... DATE ................. f" .....-•---...:.....--•........................... sra. .� ..._.. vt- -------------- a a - ..ice :': '�` �<, .......9 - c .. ... . ..........F.-... .......... . .. o , ......._. ...._..._ Final p ................ �j Eli 13 2!a 1.,6t} .. ate4,................. AN 1 AQUiN LOCAL HEALTH DISTRICT $/76 3M