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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �Sl 3 Permit No. __------ ---------- --- ------------ ------------------------------ ----- (Complete in Triplicate) .b (f p Date Issued _ / _�- � This Permit Expires 1 Year From Date issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein d Gri is pli tion 's made in compliance with County Ordinance No. 549 and existing les an�egulations: ------- 4,D a� ' psis ACT ------ JOB ESS/L 10 ��- -- - !r`' "- - lJ -----Phone ---------------------------- r Owner's me __ =�/� - ---- - -K----=-`-��--- -------------- Address ----------- -------- ------ � -- �. - - ---------------------------- - - City !---- ------- - Contractor's Name -------------------------- �-------------------------------------------- .License # -------- ---------------- Phone ------------------------------ -------------- - Installation will serve: Residence impartment House❑ Commercial ❑Trailer Court i0 Motel ❑ Other ------- --------------------=-------------Humber a of livingNumber of bedrooms _�------Gar age Grinder ------------ Lot Size Private Water Supply; ublic5ystem and name EJ ti Character of soil to a depth of 3 feet: Sand'❑ Silt 0 'Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam C Hardpan p Adobe ❑ Fill Material -----------,3f yes,type ----- -------------------- `1) ;z of lot location of system in relation to wells, buildings, etc. must be placed on reverse side. -- ' (Plot plan, showing size , NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer i available within 200 feet,) / . Ligvid Depth - - ------------PACKAGE TREATMENT [ ] SEPTIC TANK'[ S;ze --__-X-� --:` -- o / �. 'Material _ No. Compartments Capacity 1600------ Type. � f : / Distance to nearest: Well ___ ------------ Foundation ___1D-_--________ Prop. Line _ __--�.---•-•--- -_ Total Length - = ---------- LEACHING LINE [v� No. of Lines ____- ____ _ g g -- - __-- _ Length of each line'-------- :-- 'D' Box --- ------ Type Filter Material __�� ---_- -Depth Filter Material ____l_1.______.---fir-f J Distance to nearest: Well _- -------------• Foundation _.��-__-------------- Property Line _�-------•-----•--- �, SEEPAGE PIT [ Depth _ .-- ----- Diameter _ rte•'______ Number __--__- ------- - ----- Rock Filled Yes No --Rock Size /- ------- ` ------- F Water Table Depth -------- = -------- f f f --------Foundation ---- Prop. Line __:� ------- ------- Distance to nearest: Well ----- ---------- .. - 1, { REPAIR/ADDITION(Prev. Sanitation Permit# ------- -_-' �-------------------------- Date - --------•---------•-------------1 — f [_i ------------------------------------------------------------------ ------------- ---- -------- -------------- Septic Tank (Specify Requirements) ______________ Disposal Field (Specify Requirements r` =-------------------------- ---------------------------------------------------- ---------------__ ----------------- --------------------------- ------------------------------ ---------- --------------------------------------------------- --=-------------------- --------------- - - --------------------------------t------.------------------=---------------------------------------- --- -- ----- -- --------------------- � (Draw existing and required addition on reverse side) I hereby certify that I haverepared this application and that the work will be done in accordance with San Joaquin Ii, 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 f as to become subject to Workman's Compensation laws of California." / 4 Owner Signed ----- - ----------------------------------------------------- -Title ----- ----------- -------- -- -------------------- -- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------- �_�----------------------------------- = DATE ----------------•-------------------------- DATE --------------------------------------- BUILDING ----- - -- -------- ------- --------BUILDING PERMIT ISSUED --------------------------- �---------------- ; ,�� - - . ADDITIONAL COMMENT. , �'`-.z-�- _ f- AD-,?/ -�1/ �t �(�/J --- -------------- ______,r_ - - Vr- - - F ------- --------------------- __ Date _ f Final inspection by_ ________________ SAN JOAQUIN LOCAL HEALTH DISTRICT