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'�` APPLICATION FOR SANITATION PERMIT t Permit No. Compfete In Triplicate) . .... ............................................. This Penult Expires 9 Year From Dpte Issued Date Issued ..fl: -7� Application Is hereby made to the San Joaquin Local Health District for a{permit to constrict and Install the work herein described. This application is made in comp) ce with County Ordinance No. 549 and existing Rules and Regulations, JOB ADDRESS/1 TION i �r��.... CENSUS TRACT Owner's me .. i .......................... V <�ddress ra .. r_7� ...................................,....................................., Ph-one 4........._'..............._.. ........................ City . ... ..... ........._ _....._...- Contractor's Name1 ...--d................ ....................:.....................Licenseaz�l .... Phone .-. Installation will serve: Residence jRrApartment House Commercial❑Trailer Court C) Motel i ❑Other___.._.--••----------------•-----...__._.... - Number of living units:--:. Number of ` •---•• M01071 � t,;car age Grinder2k-.-.. Lot Slxe ./�:�._� Water Supply: Public System and name --- .... r .. ---._......._..........................................Private 0 IJ Character of soil to a depth of 3 feet: Sand 1] Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam ❑ Hardpan❑ Adobo)' 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. NEW INSTALLATIONt (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) PACKAGE TREATMENT [ } SEPTIC TANK j { Size................................................ Liquid Depth k Capacity .................... Type ......._.........._. Material- ....._......_......... . ............_....... � ..................... No. Compartments .........---•........ Distance 'to nearest: Well . _....._Foundation ...................... Prop. Line t► BEACHING LINE [ No. of Lines . ....................... Length of.......................... eO -- ....................... ch line. Total Length ........................... 'D' Box ............. 'TYAe Fitter Material ..:.................Depth Filter Material w ate Icl ........................................�. , Distance to nearest: Well ....... ................ Foundation SEEPAGE PIT ......... Property line ................. ; ............... [ 0 Depth .................... Diameter ................ Number r Rock filled Yes ❑ No Water Table Depth ................................................Rock Size ................................ , i Distance to nearest: Well Foundation ...... Prop. Eine " REPAIR/ADDITION(Prov. Sanitation' Permit# .. ....................................... Date .................................. � .........~......... ` Septic Tank (Specify Requirements) _ 1 7isnosal FiOd (Specify Requfrem nts) ..... . �`_ . - --. .... ..1................ I: . . .................................................................. ---. ..................... (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 Ilcen- 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 porsen In such manner as to bec Asu ett to orkma 's Compensation laws of California." ^� .fined ..... ......... ... .. . . ......P ............. Owner By ....................... .. h n o . ...... 7itfe (ff ter than owns r............ DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ....- DATE BUILDING PE . . ........................................... /....:. PERMIT ISSUED ...7L. . . ...................................................... ' ' . ADDITIONAL COMMENTS .... ....................QATE=.:....................-•---......._....--- ................................................................. FinalIns ......... ............................... --.......� pection y: ...-. . .... .. . . ................Date ... RAJOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M