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I�VR OFRU Use: APPLICATION FOR SANITATION PERMIT 3�7 .� ............................................... (Complete In Trfpllcoh) Permit No, ..��............. �� .................................. • .' ... ......... ........... This Permit Expires 1 Year from Date Issued Date issued ............ ..: G 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 compliance with County Ordinance�No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ......................ski .•.........................CENSUS TRACT .......................... Owner's Name ! .. .. ... ... . . .... .. ..............................................................Phone ....... ........................... Address .................... .---•-• ---•.._.........................._...........City ..........................................................I.................. ...... ..... Wil... ...._ Contractor's Name . � •-- --• " . ........................ ..License # - .74".7ol-9.. Phone ;UY�--:�.;i�S'..r J.' Installation will serve: Residence❑Apartment House C) Commercial❑Trailer Court C) Motel❑Other t......................:....... Number of living units:------------ Number of bedrooms Garbage Grinder ............ Lot Size ----•....................................... Water Supply: Public System and name ..................................r.....................—......._..........................................Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loom ❑ Clay Loam ❑ i - Hardpan❑ Adobe❑ Fill Material ............ If yes;.type............... ............ (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed an reverse sicl*f NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer Is available within 200 feet,) PACKAGE TREATMENT I 1 SEPTIC TANK f I Size.........................................•_.___. Liquid Depth Capacity JIM...... Type ..�r �`:Material...........I__._..._.. No. Compartments ..a.�............ . ' Distance to nearest: Well fib.............................Foundation .& ............. Prop. Line • E tLEACHING LINE [ 2 No. of Lines .-•-- ----------------- Length of each line...7��............... Total Length ............................ 'D' Box ------------ Type Filter Material .....Depth Filter Material ................................ • • , Distance to nearest: Well .... Foundation ? � -•----••----........ .........................Property Line ...................... E p . Rock Filled Yet ❑ SEEPAGE PIT Depth Diameter Number ........................... No Water Table Depth --•••----•--••-•................................Rock Size ................................ Distance to nearest: Well ----••..................................Foundation .................... Prop. line -------------------11 REPAIR/ADDITION(Prov. Sanitation Pernnit# ....................... .................. _ Date ......................... F Septic Tank (Specify Requirements) .............................•-_......... .......---..................._.................... ... ......... , ...............9� " Disposal Field (Specify Requirements) .................................•--......--••--....--•-•----••-......................_... .......................................... 1Drow existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will be done In accordance vAth Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Hem* 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" V Signed -------"_. .. Owner ._.. ............................ yitle ........................................................................ If other than owner !PR DEPARTMENT USE ONLY I,! APPLICATION ACCEPTED BY ------------------ .,..............-....................................................... DATE .,. ........... BUILDING PERMIT ISSUED ..DATE ADDITIONAi. COMMENTS •........ • ! .....................• ----........- ........... .................................. ....................... . Final inspection by: ........ .................-......................................................................D( .......... EH 13 2h 1-68 Rev. 94 SAN JOAQUIN LOCAL HEALTH DISTRICT 8f7h 3M � 1