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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ....................................... ............••---•--• , {Complete in Triplicate} •.._......... _....__.................... p Date Issued fres 1 Year From �........_..::.... This Permit Ex Date issued and install the work herein Application is hereby made to the Son Joaquin Local Health District for a per to construct described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: __.......CENSUS TRACT ...:........... ........•-• JOB ADDRESS/LOCATION �Ja� ' f "'....... ............ .Phone ................. ._............. Owner's Name � l. . . _ Address � f ......................... City •------• ---------_----. pho � :�-- ../. ?_.. � ...._ .License :� -0.41 Contractor's Name .--_-- bA V�� ........ te I Installation will serve: Residence ❑Apartment House] Commercial ❑Trailer Court C) { f'livin 'units ..... -. Number of bedrooms ... --.Garbage Grinder ............ lot Si t + ❑Other ............................................ Mote Number �o g ' Sandy--l.aam •--....---•.......Private ❑ Water Supply: Public System and name ...................................................... ❑ Clay Loam j I' Character of soil to a depth of 3'feet: Sand'❑ Silt❑ Clay ❑ Peat-El Hardpan ❑ Adobe'❑ Fill Material ............ if yes,type . Y ;•e buildings, etc. must be placed. on reverse side.) {Plot plan, showing size of lot, location of system in relation to wells, i•.` NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer is available withih-200 feet,)- SEPTIC TANK, Size...................... ... ............... Liquid Depth'... ._ ..... PACKAGE TREATMENT j � t � ""-"'-- •"'��- Capacity ' Material-----•-•-- -----•• No. Compartments -••••••� r Foundation . Prop. ...................... . Distance to nearest: Well .................••-- Line _ Len tk of each line._- — �`P-. Total Length .TP'----._..... f LEACHING LINE No. of Lines =• 9 { 1 :x 'D' Box Type Filter Material _......Depth Filter Material ........................... - Distance to nearest: Well ...:.................... Foundation Property Line ..................._.._. " UUAc T [ j Depth 3_X10/�4Dlameter Number ^:... ...:................. Rock Filled Yes ❑ No 1❑ ,� Rock. Size .............. _ Water Table Depth _. ...----•• •--•-••........... Line .................... ---- Prop. 1 , Distance to nearest: Well ..Foundation �;........:..... . � _ Date ._...._..) m REPAIR ADDITION(Prev. Sanitation Permit# -__-----••---------- •-•-•••.....••.... ............ .......... Septic Tank (Specify Requirements) -•-.._.....---••-•--------------•-••--•-----------•--•---•---•••.._.... Disposal Field {Specify Requirements} ..................................••---..........•............................-----...................... ....._....--•---------.. ..._...... -. --------------•--• -----.. ..... I .....................................................-:..._.....__.........._................-........._..-._.__._.... {Draw existing and required addition on reverse side) 1 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 Heaith 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 Compensation laws of California." Signed .......... -• ............. Owner - x tie _ .......................... :. .._ ._. ... . ........... :. i By .......... ..... ... ; (If ofi er t a owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ...............•.................... DATE ........... ...�... ... _ ....._.. BUILDING PERMIT ISSUED ;t;�5= ........... .......................... ADDITIONAL COMMENTS _....... ....-•---------------••---....:..._..................-•---- .----- ........-•....................•......................•...:.__........_.........-----•----------.....:.........---- .......__.......... ------._ .._......__ .s ... ........ ---- ••-•---_... . .............................Date . ..0 _..._.... Final Inspection by: •. ....... SAN JOAQUIN LOCAL HEALTH DISTRICT 7172 3 M r VA 24, •.Ca o_ RAA