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APPf",'ATIO" rVR SANITATION PERMIT I`"•' (Corn lete In Triplicate) Permit No. ------------ --------- �..: ------------------------.......•------------- This Permit Expires 1 Year From DaNlssued Date Issued .. ?. /7_....� .pplication is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work herein escribed. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations, DB ADDRf55/iOCAT pp_.._.�� --- --- _.. s_.�it.1Lt� l .�. CENSUS TRACT .................... nwner's Name ... - s ---- ]�_ cam.. ----•-•---------•------•-•........... ..........:..0.. ... .....-... ... ...................... ddress CS��7D �------------------city 1•! �• - -------- --- --------•- --------...----.....---•._ontractor's Name ------ ----------- License # -•---•-•-----------•-•-- Phone ......._....._._..........---- stollation will serve:: sidence i�nt' House❑ Commercial❑Troller Court ❑ Motel ❑Other.....................-..................... . umber of living units,._./------ Number of bedrooms ............Garbage Grinder --------- Lot Size ............................................ 'atei Supply: Public System and name ....................................................-... -..--------------•--- ............................Private ❑ -iaracter of soil to a depth of 3 feet: Sand 0 Silt❑ Clay (9—lPeat❑ Sandy Loam❑ Clay Loam ❑ Hardpan❑ Adobe ❑ Fill Material ............ If yes,type............... ............ lot plan, showing size of lot, location of system In relation tor wells, buildings, etc must be placed on reverse side.) EW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) 1CKAGE TREATMENT [ ] SEPTIC TANK{ ] Size................................................ Liquid Depth ..................._..... Capacity ------- ......------ Type ----------•-----_- Material............... ------ No. Compartments ...................... Distance to nearest: Well ....................................Foundation -------------- ....... Prop. Line ------.--.--------_— � ACHING LINE [ ] No. of Lines -------------- ......... Length of each line --------- ------ Total Length ...................... S Type --..—Depth Filter Material ................ . C 'D' Bax ---•--_-_--- T e F#Iter Material -••-----.-.-• _ ....--.•-.--•-••.--•.••-.- Distance to nearest: Well --------------------_-_ Foundation ........................ Property Line ........................ EPAGE PIT [ ] Depth .................... Diameter ................ Number --------_.._.---..-_.._--_-• Rock Filled Yes ❑ No ❑ Water Table Depth ..........--------------------------------------Rock Size -------••---•- •-•-•--•----•---- Distance to nearest: Well ........................................Foundation -----_------------ Prop. Line ...................... D PAIR/ADDITION(Prev. Sanitation Permit# -_------------------_................... Date --------_---------------------_) Septic Tank (Specify Requirements) ---------------- ---•--r--•----------------------------------- ---------------------------� Disposal Field (specify Requirements) "r ......... T � O- -1J�1�.�r ' ----------------------------=--------------------••------------------------------------------------------------------- -o� -----------_I—... . ----- ------------------------------- ---------------------- ------ ---•------------------------------------------------....._ ...............)- (Draw existing and required addition on reverse side) tereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin unty Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Hoene owner or licen- i agents signature certifies the following: certify that In the performance of the work for which this peranit Is issued, I shall not employ any p rnrch Manner to become ppiect to W man's Co7TA tionews of California." ` ned _. -.. - ' - -� -- -- - �� T ------------ Owner ; _- --------------- - -------------- --------------- - ---------------- Title .. . . .......... .. (If other than owner) _ FOR DEPARTMENT USE ONLY PLICATION ACCEPTED BY . . --- -- DATE ILDING PERMIT ISSUED - - . ...-... .DATE ------------- D#TIONAL COMMENTS - --- ---- -- -- - ----------------------------- .. ......... .... ..- - - al inspection by: - - . ..--------- � - ----�...... ......... . - ----......... . . ..- Date �i `� .�... . . - 13 2 z-b13 iv• SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M L ,