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FOR OFFICE USE. ~ APPLICATION FOP SANITATION PERMIT Permit No. . .. ...................... . � 3 z ` . ........ .... ......:. (Complet;in Triplicate) 7 7 This Permit Expire'saI year From Date Issued Date Issued ..5+:_.. Application is hereby made to the San Joaquin edl Health District for a permit to construct and install the work herein described. This application is made J'n compliance with County Ordinance No. 549 and existing Rules and Regulations: h.. � .. . _ JOB ADDRESS/LOCATION ....'.. 7.__. . ..`-�-s�. CENSUS TRACT .......................... ii. Owner's 'Nome Phone.` .. �n��......... ------ --•------- - ---- Address ---................R :... ...4......�. ...................... Contractor'4 Narn-e _...............!� �.'� r license # -393 Phone r .. __...... ......._.... Installation ►ill:serve: esidence1�1Apartment House❑ Commercial ❑Trailer Court 0 i' Motel ❑Other ............................. ........... Number a€ living units------ ----- Nur. of bedrooms .../ ....Garbage Grinder Lot Size . 11..... ..................... Water 5uppiy: ublic System and name . ...............................................Private ❑ Character of soil-to,a depth_o0-feet: Sand❑ Silt❑ Clay ❑ Peau❑ Sandy Loam 0 Clay Loom [I (� Hardpan❑ Adobe Fill Material If yes,type ............................ (Plot , showing size bf `Ibt,-3acotion o€. system in reldtlon to wells, buildings, etc. must be placed on reverse side.) V NEW INSTALLATION: (No septic tank or seepage pit permitted public sewer is available within 200 feet,). PACKAGE TREATMENT [ } FSEPTIC'TANK Size ---------------- Liquid Depth ..:................ Copacity ---- ... . Type .................... Material -----.._.... No. Compartments -•--- ..........._ .'s.. if Disif6hce to nearet:$,Well ......-.•:--•-.-.-•.................Foundation ... ...................Prop. Line ....................... r4o. -� LE=ACHING LINE [ j No. of Lines .r _- _......_. Lengthy of;each line I Total Length ............................ 'D _.- - - - - - - x' Bo -- Type Filter Material k«: •-------------_-.Depth � � } � Filter Material . D,istonce to nearest: Well ........................ Foundation . +,r�..... ..... Property Line ... ............... , SEEPAGE PIT [ j ..-_..{.._..__.... Diameter ............. :. Number ...... .. . ....._........ Rock Filled Yes [3 No C3Depth • Ware Tablet Depth; __ Rock Size --------------•--_-.------.--- Distance to-nearest: .................., Foundation _---_------.-.__-.-- Prop. Line ._ REPAIR/ADDITION(Prev:-.Sani anon Permit# __..--..------ ------------ Date -- --------------•---------_.--.-) SepticTank (Specify Requirements) ................................. --------•----------..... .._.................._...............-.............----------------•- Disposal Field (Specify-i.Requirements) .....- ..... ... - Xa --•- x�tJ�..........................•---•-•-- ................... ................ . . ....................................................... ....................... -•--------_..._. _.... ..........-.............................................. --,(arow existing-and-required 'addition on revese side) I hereby certify that 1 have prepared this application and thatl the work will ibe done in accordance with San Joaquin County Ordinances, State Laws, and Rules and 4egulations.of-the.Son Joaquin Local Health District. home owner or licen- sed agents signature certifies the following: "I certify that in the performa6ce•of the work foe which this peri ids issued, 1 shall not employ any person in such manner as to become subject to Workman's Cornpensation laws of Californla." ' Signed .................. c ....................... Owner r t BY ...._...'e .......:..........• - Title ... (If othe t on owner) . .0 F R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .. I t . .:(.. .............. DATE 5`� 14 ........... BUILDING PERMIT ISSU:D .... . .........•--•.........1.............. :... ........:__...DATE ADDITIONAL COMMENTS ` ` ' -- .............•------• ...----•-...__...... ... ..........................•..................... ..................................... • . -. . ---•• .__._..._...--.. .............-•---•--- - - ...------------------------------------------------ .....-•-----------•------------------------- ------------ ........................................... .. '.. _.____.... _.._.__._.__..._...___...............___t.____...._.__............ ------------------------------------. ____-__-__...__... Final Inspection by: ...: '--.. . . _ .............................•--...D"ate`............ � `.......... SAN JOAQUI14`1 CAI'HEALTH DISTRICT- E. ISTRICT-E. H.13 241-'G8 Rev. 5M _- - 7/723,,,.4 _