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FOR OFFICE USE: ' APPLICATION FOR SANITATION PERMIT Permit No. a� S�9 k {Complete in Triplicate} _______ ____________. ------------------------------------------ ------- ---- - This Permit Expires 1 Year From Date Issued Date Issued Application 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 County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ._ (�. �--/-h- .G�. --------------------CENSUS TRACT ---------------,.-.--•---- Owner's Name ----------------- -------Phone ---------------------------- Address ------=------- 2�, ?id -,d_ _ , lP _IV&-.c_0."_ + '.ti ------------------------------------�/ Contractor's Name-794042- R _ ii ._ L� #18 �r _.._ Phone4 &� A.' Installation will serve: Residence)eApartment House❑ Commercial :❑Trailer Court !❑ '+�•,,. � Motel ❑Other -------------------------------------------- Number of'rlivirj`g'units:_--- ------ Number of bedrooms _,�_ ____Garba e Grinder __tA0... Lot Size __ Water Supply: Public System and name ----------------------- --- ---------------------- ------ ---------------•------------------------•---------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam-t Clay Loam ❑ i Hardpan ❑ fAdobe.b( Fill Material ------------ If yes, type ----------------------------- (Plot __-_-_-___-_____-______(Plot plan, showing`size of iot, 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 i available within 200 feet,) ' r �� I r/ PACKAGE TREATMENT � SEPTIC TANK [ ] Size__�__� _______,�____.__._.___.__ Liquid Depth _______________ # Capacity 13-!60------- Type --------------------- MateriaMZe ---- No. Compartments ----- ------------_--- Distance to nearest: Well �I Foundation ------ Prop. Line -------- LEACHING LINE No. of Lines ._. __.____-____ Length of each line-- -�__-_-__-- Total Length :._ _r ----- D' Box . ___ .-__. Type. Filter Material p re De. th.-Filter .Material -----f_ Distance to nearest. Well ? -_-__-___ --- Fot datio '_ ,Property Liner0__- __._-_ .; SEEPAGE PIT Depth --R� Diameter z--3-__-_ Number""i- - ______-___,•Rock FilledYe No ❑ Water Table Depth ----- -------------- -------`_- _Rock"Size ---X-. - ------_ i t Distance to nearest: Well ______ ______________ _Foun-Ation l r Prop. Line ..-----��------- REPAIR/ADDITION ..Nt REPAIRJADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---=----- ---_.----------------) Septic Tank (Specify Requirements) �. �' r. -- Disposal Field (Specify Requirements) --------------- ------- - �------------------------------------------ -------------------------- -`---------------------------- ----------- --- ------------- i----- 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 E 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 "I certify that in the performance o*thhework for whi4thnermit isissued, I shall not employ any person in such manner as to bec" bject t Work n's lifornia." 'oe :Signed --- -------- �`By --- --- ------------------------------------------------------ -------- --- Title (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --. ------- - -- --- ----------------------------- DATE ----------------- BUILDINGPERMIT ISSUED ----------------------------------------------- ------------------------ ----------------- ---------- ---DATE ------------------------------------------- ADDITIONALCOMMENTS ------------------------------ -------- ------------------------------------------------=-------------- ----------- ---------------------------------------------------------- --- ---------------------= -:- - - -- ----- ---------------------------------------------- ------------�---�---L-------- --------------- - -------- ------------------------------------------ ---------- --------- ------------------------- ------------------------------------------- -------------------- -- - --------------------------------------- - --------- ------------------------------------ ------------- ------------------------------- Final -- ---- ---- ------------ Final Inspection by: -- --- - ----- - -- ------------- ---------------------------------------Date --------------------------- -- - ------- SAN JOAQUIN LOCAL HEALTH DISTRICT