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FOR OFFICE USE. -- APPLICATION FOR SANITATION PERMIT --------------- 4.- -- __ _ " " (Complete in Triplicate) Permit No. _ ""3 =---------- I� --- This.Permit Expires i Year From Date Issued Date Issued _'!S-�U 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 I�- _• "............ ' a Owner's Name !` 6�J ------CENSUS TRACT ---- - - ---- -- -- ------- Phone Address l --------------. City Contractor's Name --- --- ' �- - -- -- y � --------------- ---License # ------- --- Installation will serve. I ------------ Phone-5/ Residence 'Apartment House-E] Commercial ❑Trailer Court i❑ Motel [ � Other -------- ------- -------------- ----- ---- Number of living units:-- "l------ Number of bedrooms _-s3----_--Garbage Grinder _ - --- Lot Size Water Supply. Public System and name _ _ PP Y� Character of soil to a depth ------------" Private of 3 feet: Sand'❑ Silt❑ Cla Y ❑ Peat❑ Sand Loam Clay Loam ,0 Sandy Hardpan"IF) Adobe❑ Fill Material ------------ If yes, type ---------------- ----------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must belac NEW INSTALLATION: p ed on reverse side.) {No septic tank or seepage pit permitted if public sewer is available within 200 feet,) Q f PACKAGE TREATMENT [ I SEPTIC TANK: Sizep - - ---- Liquid .Depth --7�-------- - Capacity / rOo y�,,�,, • - ---- IN Type� `` "` real--- _- No. Compartments _P" _ -1............... LEACHING LINEDistance to nearest: Well _________________ ___"•Foundation _fa----__ -------- Prop. Line -�ro...I ............. �j No. Mf Lines ------------------ ` Length of each line-- - ------- ------- Total Length ----........---- V Box wi pe Filter Material�/�_ Depth Filter Materia! ---!" ----------•----- Dista lnce to nearest. Well -------------------------Foundation ------ Property Line ---------------•-------- SEEPAGE PIT -----•------------------ � [ l Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No ip Water Table Depth ----------------•---- .......Rock Size -------- Distance to nearest: Well -_---__"-____---""-" _..Foundation k Prop. Line ..-------•-•------ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date --------•-----------1 Septic Tank (Specify Requirements -_---__- ------I-------------------------------------------------------------- - Disposal Field (Specify Relquirements) ---------------- ------------------------------ ---------------------------- ------- ------------- - (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 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 an as to bec a object t arkman's CompZt' laws of California." � p Y Y person in such manner Signed --- � r� y, Owner BY /CI -ted•- �!✓ Title `,, -------------------- FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY BUILDING PERMIT ISSUED - ADDITiONAL COMMENTS _- -------------------- ------- ---•------------------- DATE ' } � L '�t E -- ----------------- i - ------------------------------------------------------------------------------------------------------------------------------------- --- - - -- Final Inspection by: --------------------- - �} y SAN JOAQUIN LOCAL HEALTH DISTRICT i E. H. 9 7-'6$ Rev. 5M