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a FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----- ------------- ---- -------------------------------- (Complete in Triplicate) I` Date Issued _/ -I y This Permit Expires 1 Year From Date Issued -------------------- lication is ereby the San Joaquin Local alth rict for a mit to construct and rein described Thishapplication eis made in compliance with eCounbtytOrdinance No. 549 and existing Rulestalnd hRegulationns: r' �' �` -----------CENSUS TRACT JOB ADDRESS/LOCATION ._��--- � --- �--� ------------------- ------------- - Owner's Name -- ----- �--- ---------------- ---------- F Phone --------------------------••-------- -------. City .a �`-` ---------------------------•------•--•------ Address `.�.V-� � ---- ---------•--------------- - i Contractor's Name �+�e�, � �'`� License #/ _- Phone -= ` Installation will serve: Residence I'd House❑ Commercial ❑Trailer Court F1 Motel ❑ Other -------------------------------------------- r .f Number of living units:--/_--- Number of bedrooms _47----Garbage Grader ,,��- Lot SizeXtI-Y°----------------------- Water Supply: Public System and name - l�f --- ?�t "� � 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. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) r PACKAGE TREATMENT [ I SEPTIC TANK'[ ] Size------------------------------------------------ Liquid Depth ------------------------- --------_--------- Capacity --------------- ------------------- •----Ca acit ----- Type -------------------- Material---------------------- No. Compartments Distance to nearest: Well ---- ----------------- _____-Foundation --------- ------------ Prop. Line ___-_____----------- LEACHING LINE [ ] No. of Lines ----------- Length of each line---------------------------- Total Length ---------------•----------•- 'D' Box ------------ Type Filter Material ____________________Depth Filter Material -______________---------------------------- Distance to nearest: Wel! ----------- --_:-i--- Foundation ------------------ ---- Property Line ------•-----------_-- SEEPAGE PIT [ ] Depth _________________ _ Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No 0 7 Water'Table Depth Rack Size ------------------------•- --w z. P _ •-- r _Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line -----.---------------- . REPAIR./ADDITION(Prev. Sanitation Permit# _____________________________ __ ---------- Date ------ --------------------------) _ Septic Tank (Specify Requirements) --------------------- Jr � ---------- /---------- .------------------------------------------------------- Disposal Field (Specify Requirements) ---- -------- ------------- - -------t--•------------ •--------- ------------------------------------------------------------------------------------- -------•----------------------- ------------------------------------- (Draw raw Existing and required addition on reverse side) I hereby certify that 1 have prepared ithis. 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 Complensation laws of California." Owner I Signed ------------ - �P T ,% BY ------------------ Title _.- C ------ -------------- ------------------ (If other than er) t ,t FOR DEPARTMENT USE ONLY" r ' APPLICATION ACCEPTED BY ..% Y - -7�� -------- DATE - - _-' Fm-- --- ---- � DATE --------- ------------ ------------------ BUILDING PERMIT- ISSUED -------------- :N --------------_d �------------------ ADDITIONAL COMMENTS = . ___ __.______-.._____._____..._ ___•_ _ -_ -._ _.________ _________________% I __. ________________ __._____-_ - Final Inspection b ------------ ----Date ----------------------------- -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M F W »