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-FcaK UF1=10E USE: APPLICATION FOR SANITATION Prll i, -- --- --... . -- ------ ------------------- „ . Perrnit No. (Complete in Triplicates - w.,---------------- -------------------- ...................... This Permit Expires d Year From Date IssuedDate 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 ._. ...�- % �.- -- (�---- ....-.-_.___ rE�- ----CE=NSUS TRACT Owner's Name �c�' ✓d, sL� ,..-ft$A_ crLs - ------Phone ------------- ----------•--------- Addressdr id -- --- (- .---- A City 'h�C.. Contractor's Name .------- 1 ,.,. -- - --, _..License #f� 7 _r2-.._ Phone ---.--------.------- ......... Installation will serve; Residence ❑ Apartment House,[:] Commercial ❑Trailer Court ;❑ Motel ❑ Other _141 -----( Number of living units:-.. -._.. Number of bedrooms ..__--__Garbage Grinder .._.. Lot Size _..- �� •*— -y---.----- "� Water.Supply: Public System and name ---------------------L ----------------------------------------- ---------------------------- ------------ --------- - - - - . . Private [�J Character of soil to a depth of 3 feet: Sand❑ Silt E] Clay [I Peat EJ Sandy Loam Clay Loam 0 Hardpan ❑ Adobe ❑ Fill Materia! .----------- If yes, type ---------------------------- (Pint 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-/r f-:- --,5---------------------- Liquid Depth ...4/------------------ Capacity .. . . _0_ ,.. Typef c' pe--- -- �Material�>l,:Z�-L��_t.__- No. Compartments .- --------------- Distance .............. Distance to nearer Well - ------------S�----------------Foundation -------- Prop. Line ----------- LEACHING LINE �i� No. of Lines ._._.._------. Length of each line___4,0. ........... Total Length ... ---------- 'D' Boxes .. Type Filter Material -.-----�c _,__Depth Filter Material __------��J- ....._--- Distance to nearest: Well - Foundation ------ ..Q..._.- Property Line _.-------------......... SEEPAGE PIT [ } Depth --------- ------ --- Diameter ------------- Number .--------------------------- Rock Filled Yes ❑ No 0 Water Table Depth ---- ---- --------------------------------------Rock Size ----------------------------- - Distance to nearest: Well --------------- ----------------------- Foundation ----.-----------.--- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# .....-.-._--------............ ------------ Date -------------------------------.--} i Septic Tank (Specify Requirements) ------------------------------ --- --- ------------------ -------------------------------------•----------- •--------------------------- i DisposalField (Specify Requirements) -------------------------------------------------------------- ----------------------------------------- ----------------------- ------------I------------ ------ ------------- --------------- --- ------------------------- -- -------------------- ------------ -- ------ ----------- ------t...--------------------------- ---- ----------------•------------------------ --------------------- ------ ----------------------- ---- ---- --- . ------------:-----------..---.-.------- ---- -- --------------------------------- - --- --- ----------- ---------- (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 F 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 as to become subject Workman's Compen 'on taws of California." k Signed ---------- --- -- - ------ ------------------------ Owner BY -------- ..... ^ Title Of o er than owner) _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - - DATE . -Y_�j BUILDINGPERMIT ISSUED . -------------------------- -------------------------- -- ----------- ------------------------DATE -------- ------------------- ..... = ADDITIONAL COMMENTS -- - ------ - - ------------ -- ........---•-----------{--..' -.. --------------- -- ------ Final Inspection by: ... ; } : - ---------------- -- -----------------------------------------------------Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. ;f. 9 1-'6B Rev. 5M