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iCE USE: AP�,,,CATION FOR SANITATION PERMIT �, ---- -------- Permit No. (Complete in Triplicate) - ---------------------- 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 described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCAT ON ..... LL? 1 -'f �_G� .. j/ l ...CENSUS TRACT - ----r--------- Owner's Name ------ ---------- ---------5"---------' / � f `.- --------------- --------------- --.Phone d .c�= �1�,3,?a Address - ---- '- `` City ---------------------------------------- -- Contractor's Name ...._Lc ------- .-- -.---"-`--'------------------------------------- ---------License # ----- -- -------------- Phone -- --------------------- Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court ❑ Motel ❑Other -------------------------------------------- _ Number of living units:____...-.. Number of bedrooms ___Garbage Grinder Lot Size Water Supply: Public System and name ----------------------------------------------- ----------------------Pi tvf� e U Character of soil to a depth of 3 feet: Sand'Q Silt❑ Clay ❑ Peat❑ Sandy LoamK Clay Loam ❑ (' Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type ..-.-----_-..-.-_--------- C (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 ------------------- Liquid Depth ---------- Capacity Type)C'_- Type)--- 6M�nalL", ��_iZ-[{. No. Compartments --- Distance to nearest: Well --------- __.- - Foundation _--f0............. Prop. Line -- --- __�_______ LEACHZING L1NE No. of Lines -...t -------._.._ Length of each line.......... ��.___..... Total Length ___ �(i -_________- 'D' Box ----- ------ Type Filter Material --------------------Depth Filter Material ------------ -------_----------------------- Distance to nearest: Well ------------------------ Foundation ------------- ---------- Property Line _.._...---_------..._. SEEPAGE PIT [ ] Depth --------- ---------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No Water Table Depth ------------------------------------------------Rock Size ---------- -------------------- Distance to nearest. Well ........................................Foundation Prop. Line --_....._-._..__--._._ REPAIR/ADDITION(Prev. Sanitation Permit# _-------.---------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) -- --- ----- ------------------------ -- ------------------------ ----------------- -------------..- DisposalField (Specify Requirements) --------------------------------------------------------------------------------__ ---------------------- - -- -------_ ----------- -------------------------------- ---- --- - - --------------------------------- `--------------- -----------.--------- ----.--------------- ..........- -- - - -....--- ---------- ... .............. -- -- --- -------- - - - ------- ---------.--- -- - -----------------...-..- - ---- - ------- ............. ------- -------- (Draw existing and required addition on reverse side) hereby certify that I have 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 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 becomes ject t Workman's Compensation laws of California." ,igned r. t._ 5- Z C[.L,1_ Lf' �` ----------- Owner ;y ......... ...... -- --- - -- ----... ----- Title ------------------ ..--- ------ (If other than owner) R DEPARTMENT USE ONLY 4PPLICATION ACCEPTED BY - ----- --' _. -- ------------------------------.--- .. -- .. DATE 3UILDING PERMIT ISSUED ---------------- - - -- -DATE .... .....--------------. 4DDITIONAL COMMENTS ... -- - --- -------------------------- -------------- -------�------- ------- - --- - --- --- -------------- - -........------ .-- ------------ ------- ----- ------ ---------------------------- ----- ..... } -------Date -- --- sinal Inspection b _�- -- - -------------- �---�--- - SAN JOAQUIN LOCAL HEALTH DISTRICT _in