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FOR OFFICE USE: APPLICATIOF�-fOW'SANITATION PERMIT Permit No. -� �- • ------ {Complete in Triplicate) ------------------------------------- ____-___- p Date Issued _ This Permit Expires 1 Year From Date issued A lication is hereby made 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 Co my Ordinance No. 549 and existing Rules and Regulations. . CENSUS TRACT -------------- ----------- JOB ADDRESS/LOCATION --------- � -- ---- -Phone ----------------------- Owner's Nameeq,. Z Gf-G - ------------------------ f _ Cit ��'-_-`��=Y -----------------------------•--•--- Address --------------------- ---- - , a2 r)_ SDGZ �(�',,L/------------------ Y ------- ---------_ � License# ------- -- ------- ------------------------------------------- Contractor'shone Name _____.----------F Installation will serve: Residence ❑ Apartment House f:1 Commercial:❑TrailerCourt�❑ I Motelther -------------------------------------------- LotSize -------------------------------------------- ---- --- Numberaf iviPgblicunits: stem and name Number of bedrooms ______.----Garbo a Grinder __________________________•,------•---_-___-Private ❑ Water Supply: Y i " ( I \ Peat Sandy Loam ❑ Clay Loam 0 Character of soil to a depth of 3 feet: Sand' Silt❑ Clay ❑ ❑ \ Hardpan ❑ Adobe.❑ Fill Material ----- If yes,type _ O (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 [ ] SEPTIC TANK'[ ] Size-------------------------------------------- Li --------- Liquid Depth th -------------•-- Capacity ----------------- -- Type -------------------- Material---------------------- No. Compartments ------•-----.-•--_---- } Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ----------•-•--------- --- Total Length ----------- ----•- --------- LEACHING LINE [ } No. of Lines _---------------------- Length of each line---------------------------- 9 'D' Box .---------- Type Filter Material --------------------Depth Filter Material _-____.--------- _____________ Foundation Property Line ________---------.------ Distance to nearest: Well ___-___-- ---- ---------- ------- De Depth Diameter __--_ Number ---------------------------- Rock Filled Yes ❑ No SEEPAGE PIT [ J P --------- Water Table Depth Rock Size -------------------------------- F Distance to nearest: Well _._______________________ ___ ------Foundation ------ Prop. Line --------------------- Ylr>r _ I REPAIR/ DITION(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 hake 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 Lo al Health District. Home owner or licen- t sed agentsFsignature certifies the following: t "I certify thatAn the performanc of the work for which this permit is issued, I shalyr of employ any person in such manner as to beco f[t:to 0 r s Compensation laws of California." .� Owner Signed __._ -_�° = -- --- ----- -------- - --------- -- - -- Title - -------------- G �( ------ If otherer^than owner) [ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- -------`---- DATE ------ I---7----��----- ------------- BUII DING_PERMIfISSUED-_-._ - -----------------•----=-- - DATE------------------------ - -• -- - ADDITIONALCOMMENTS --------------------------------- =-------------------------- ------------------------------------------------------ ---------- ----------------------------------------------------------- ----------------------- ------------------------------------------- - - ------ ?