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r lux utfl x Mir: APPLICATION FOR SANITATION PERMIT ........:........................................... Permit No. ........ ��..., lComptete In Triplicate) ....................................... ...... ..•. . This Permit Expires ! Year From Date Issued Date Issued 46 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 Countv0d1.n nce No. 5+49 and existing Rules and Regulations: JOB ADDRESS/LOCATI ./4..../ .........•••••••• •••• ••• • • •CENSUS TRACT .......................... Owner's Name . ........................................ .......----........................Phone .................................... Address ........................... _ ..................._._,.City .......................................... ....... ..� .. .. . g Contractor's Name -- ...... ......._.. license #,27j,1 icZ.__ Phone Installation will server sidentertment Nouse[] Commercial ❑Tralfer Court ❑ Motel❑Other-•-•--•..................................... t Number of living units:............ Number of bedrooms .k.....Garbage Grinder ............ Lot Size ........................................ �A 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 p Adobe 0 Fill Material ............ If yes,type............... ............ (Plot plan, showing sire of lot, location of system in relation to wells, buildings, etc, must be placed on reverse slde.S� NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT I ] SEPTIC TANK f I Size.. ............................................. Liquid Depth ....................... Capacity . � Type . Material---------------------- No. Compartments J. .............. ' Distance to nearest: We .._ � Foundation _:_.-- Prop. Line .. •------------------- �� ........._..... ------------------- LEACHING LINE ( J No. of Lines . ....... .......... Length of each line............................ Total Length ..Xjtl ....,. / f 'D' Box I.....---- Type Filter Material ...... :.. ........Depth Filter Material .. ........_.._..............._..... r . , Distance to nearest: Well ........................ foundation ..............:......... Property Line ....................... SEEPAGE PIT E g Depth Diameter ................ Number ............................ Rock Filled Yes ❑ No i Water Table Depth --•-•-------- ............................... ..Rock Size ............... Distance to nearest: Well ........... • ...--- .... P- •---------------------- -------------Foundation ---•--•--•----...... Pro Line -.................... REPAIR/ADDITION(Prov. Sanitation Permit# -------------------------------------------- Date ..................................I SepticTank (Specify Requirementsl ......................................... .................---._......................................-_ --..--..-._................ DisposalField !Specify 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 Sart Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner at 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 becory�e subject Io or X s Compensation laws of California."" �/ , Signed .. ............................................................ Owner By ................... ... ............... ...........................--•--......._.._._...._. Title ......................................................................... Of other than owner) iRDP R TUSEONLY �-- APPLICATION ACCEPTED BY . DATE .... ......... ....... ... ...... BUILDING PERMIT ISSUED ....__... ........................................... •-------- ............................ -........._....._. ---.....DATE __............................... ADDITIONAL COMMENTS ..................... ............................ .............................•---.---•-••......----------------.._...__ -............__..... .._.............. .....................----...............--•----- ...._...... ............ .............................. _........ .i� �� ..Date .. ......... ................. Final Inspection by ................. ........._.. EH 13 21s 1-60 lZov. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M