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FOR OFFICE USE; FOR OFFICE USE: APPLICATION FUR-SANITATION PERMIT 7f,1/IS� Permit No------ ------- --•- --- (CompFete in Triplicate) ------------••-•- r .. 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 compiiance with County.Ordinance No.-549 and existing Rule's and Regulations: . .._ ✓ :.CENSUS TRACT------ : JOB ADDRESS/LOC 10 1---.- . - .-- h Owner's Name....,. 1 :- ..._..Phone........ (� .. Address_. Com - ...City--- ------- ---- ----------- ZiP -.-.._...------_-•- Contractor's Name------------ -- -- ..----License Phone-.- '= �� jS- •� Installation will serve: Residence Apartment House E] Commercial E] Trailer Court El Motel ❑ Other--- ---------- -•--• ..------- Number of living units:........I_..-.Number of bedrooms._----.Garbage Grinder............Lot Size...... -- •--- ---- Water Supply: Public System and name-- --- _- __ .__—:, Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe ❑ Fill Material-. __.. ....If yes, type........-- -- (Plot plan, showing size of lot, location of system in relation to wells, buildings;etc,' ust be placed on reverse side.) g k NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) Size.---- ----- -- ...Liquid Depth ----- - PACKAGE TREATMENT [ ] SEPTIC TANK [ ] R Capacity---- Type-'------------------ -- Material------ ............ ------No. Compartments-------- ....................... Distance to nearest: Well..:..------- ....... ... ------Foundation..---- Prop. Line------------ -----------_ ..g _.._ ., . _ LEACHING LINE [ j `No. of Lines ----------------Len th`of each line.---.-------------- .�--Notal Length .....----------------------.----------• 'D' Box--.._...,..Type Filter Material........ . .........Depth Filter Material...----......----------------------•--------_------- Distance to nearest: Well-------- -------- ------Foundation.-----.------------- -......Property Line.--- ........ SEEPAGE PIT [ ] Depth-- Number-- `------------------------ Rock Filled Yes ❑ No ❑ iameter. Num I • ._.Rock Size. .------------------•------•-...- Water Table Depth----- --- Distance to nearest: Well...........'- --- ----- -------------_-Foundation........ ....... Prop. Line-------- ---------.--------- R -- -. REPAIR/ 6( p t9 (Prev. Sanitation Permit#--------- Date-----------------.. ..._... ............ ------ - Septic Tan Secify Requirements).-__ . . .............(.. t°� - i l Disposal Field (S eFify Requirements) -- -- - =- ------ ------------- - --- ; _---------- " - --------- ------------------------ --- --------------------- --------------------- (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 County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District, Home owner or licensed 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 to Workman's Compensation laws of California." f� Signed f/ .. Owner BY ............. _.... Title... _... (If other than owner) i FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY_-.-- .... ----- ----- ------------- -------...----------- ---------- -..DATE -- �'�- ",..-d .. - DIVISION OF LAND NUMBER ._.. DATE-----------_-- ---------- ADDITIONAL COMMENTS_................ ........ ............. - -------- -- 1 . _.. �.�. Y , ^ --------------------------------------- ----_----- e` - -- -------------- ---------- -- ------- -------------------------------------- -- ...-_.. � . ..Date. Final, b .. - Fes 21677 aev �� a sM FH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT