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rvx vrriLZ rbe APPLICATION FOR SANITATION PERMIT E (Complete In Triplicate) Permit No.�� ......................................... This Permit Expires t Year From Data Issued Date Issued 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 complVionrewlth Cou ty Ordinance No. 549 and existing Rules and Regulationse JOB ADDRESS/L TION 7` 1. CENSUS TRACT ...... .................. .......................... Owner's Name ..... . ...........4........ . .......... ..Phone .................................... Address ...s5 37 _� � ....................••-....City ................................................. Contractor's Name .......... .Q �� •`.. ........................License# �lJ.:�.7... (hone .ca_5`-al d.. .f^ Installation will serve: Residence®`Apartment House❑ Commercial J3Tratler Court 0 Motel ©Other Number of living units:---f__.__. Number of bedrooms -X...._Garbage Grinder ............ Lot Size ._4W_ :....... ............. ' Water Supply: Public System and name ........................................................—..................................................Private A Character of soil to a depth of 3 feet: Sand 0 Silt Q Clay p Peat❑ Sandy Loam 0 Clay Loam Q Hardpan$( AdobeY fill Material ............1f yes,type............... ............ � Piot plan, showing size of lot, location of system In relation to wells, buildings, ate. must be placed on reverse side.) NEW INSTALLATION: No septic tank or seepage pit permitted public sewer is available within 200t' PACKAGE TREATMENT SEPTIC TANK Size Ll aLiquidDepth l. ................. Capacity /a -Q....... Type P, (.Aw..... Materia! ....... No. Compartments ....9'- •••.... .11 T .!-- Distance Yo nearest: Well' ..1 --••---�...................Foundation., ® .......... Prop. Line ... .............W _EACHING LINE [� No. of Lines -----3............... Length of each Iina..y©�.. ..c/9. Tota) Length e2� ........... ' 'D' Box :.......... Type Filter Materia! ;- L Depth th Filter Materia) ...,��.'...:.......... . . ........... Distance to nearesh Well . ./0.34)..... foundation . . .11............. Property Line �?`�.................... re SEEPAGE PIT Depth ....4as....... Diameter ,3.3...... Number ...........3.... ... . . Rock Filled Yes No ❑ Water Table Depth ... . ...,l eO.r.. . .......................Rock Size .. ... , .. ......._.. {, {. Distance to nearest: Well .f s ....Foundation ...& G .,Prop..Line..... .-.- k REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .................................. ) _ r .Septic Tank (Specify Requirements) ......................................... ............................................................. . ............ ........... k Disnosol Field (Specify Requirements) .................................. ...........,................................................................... . .,.......... --•--------••-••------------- I ........----------•.............--•----•---......--------....---•-----•..-•-......................... ............................. - ......................-...................-•-•-........................................................-........................................_._..-: ........................._._.. (Draw existing and required addition on reverse side) E I hereby certify that I have prepared this application and that the worts will be drd en* in accordance with San�IJoaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District, Homo owner or ticen. i 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 be s14i eet to kman' Co ensalion laws of California." .. ...... ' •.... ............. Owner By ....................................-..---- Z� .... ...... ...- ....... rifle ....�� ........................................... .......... (if other than owner) Ij FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY ........ DATE ..... r BUILDING PERMIT ISSUED ..... :..:........................ .............DATE-.:.-.................... s....... ................... ADDITIONAL COMMENTS .......... ......... .... ............................. ---..... .............................. .... ........................... . .................. ...... -...... ......... ..... ....--. ... ... . Final Inspection by: ..... ............ .............. .... --..Date / ....................................... a 13 24 1-66 Roy- 5H SAN JOAQUIN LOCAL HEALTH DISTRICT' 8/711 3M