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FOR OFFICE USE: APPLICATION 1=AR SANITATION PERMIT ,..� - Permit No. . -� --------- --- = - {Complete'in Triplicate) ------------------------------------------------ Date Issued ------------------- This Permit Expires 1 Year From Date Issued i Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein I described. This application is made in compliance with County Ordinance No. 549 and existing Rules^and Regulations: ` - ---------- -CENSUS TRACT JOB ADDRESS/LOC ION ._ - - -- -.-- , Owner's Name --- - -- - - 1--------------- ----- ------ --------- =------------ ------Phone ------- -------------•---------- Address ---- '7 - --� ----- --•:- --------==--- -- License # -f 3c �_ Phone ------------------------------ Contractor's Name ---=- - -- - 11-69 ❑ P ------ Installation will serve: Residence Apartment House�❑ Commercial :❑Trailer Court i❑ i Motel ❑ Other .__ -------- t _ _ ___________ Number of living units------------- Number of bedrooms ------------Garbage Grinder ------------ Lot Size ---- ------------ - Private dter Supply: Public System and name ________ ------ ------------- ____ _-_____ W Character of soil to a depth of 3 feet: Sand❑ Silt ED Clay E] Peat E] Sandy Loom Clay Loam ED Hardpan ❑ Adobe '❑ Fill Material ------------ If yes, type ---------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) 1 NEW INSTALLATION: ► (No septic tank or seep a pit permitte' iif�public sewer is available within 200 feet,) SEPTIC TANKSize-�S- --- - Liquid Depth ---- ------------------ PACKAGE TREATMENT [ 7 [ -- ------------------ Ca acit p� ---- Capacity ----.0-op--- -- Type ----- -------J-� Material �'E�__-�_��--��,--�_ No. Compartments ------------�-- ----- �I Foundation . .� ------- Pro Line ------`�-- --- Distance to neare Well ----------tea=- --- p• -G------------- Total Length ---- LEACHING LINE [ ] No. of Lines _____f�------------------ Length of each line_-_._� g D' Box ------------ Type Filter Material ---S___f-___ ___ _Depth Filter Material ------f I-- ----------- Distance to nearest: Well ___ ------. Foundation ___ -- ------- Property Line ......------•-------- x ----- - ------------ i F SEEPAGE PIT [ ] Depth Diameter ____ _�___ Number -.____=I.___________________ Rock Filled Yes E] No .I❑ - - k Water Table Depth ------------------------------------------------Rock Size -------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ------------•......... REPAIR/ADDITION(Prev. Sanitation Permit C# ---------------------------------I----------- Date ----------------------------------------------- Septic --------------------------------- ! Septic Tank (Specify Requirements) --------"--------- ------- -------------------------------- ----------- Disposal --------- - j --------------------------- - Disposal Field (Specify Requirements) ----=------------------------------------- -------------------------------------------------- ------------------------------- x. ------------ --------------- ------ {Draw existing and required addition on reverse side) I 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 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 become subject to Workman's Com ensation laws of California." i r Signed ---------------- ---- -- -------------- - --- - ---- ---------------------------------- Owner ' _ � Title 3. - --- (if otherithan owner) l FOR DEPARTMENT-USE-ONLY APPLICATION ACCEPTED I _ _ _ _ DATE ----..._ _.L _� y------- BUILDINGPERMIT ISSUED --------------------------------------------------------------------- - -------------------------------DATE ------------------------------------------ ADDITIONAL COMMENTS'-,----------------- - ------------------------------------------------------------------------------- _____________________________ ______________________________________________________________ ____ ______---------____ __-______ _____.-_____. ___-_.._-__-__-_ ___.__.------- ------------------- - _ _ - --------------- --- --- --- ----- - Date-! f / - - Final Inspection by.. _ - ------ - -------- ------------------------------- ------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M