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APPLICATION FOR SANITATION PERMIT ..............................._................ lComplete In Tr[pltcate►Permit No. ..t•••• This Permit Expires t Year From Databtved . Date Issued Application is hereby made to the San Joaquin to Health Distri for a permit to construct and install the work herein described. This application Is made I n e with C_ ty OMInonce No. 549 and existing Rules and Regulations: JOB ADDRESS/LOC ON ....'......... ...............CENSUS TRACT Owner's Name._, .. ............................................................... ............Phone .............................. Address .....,... 7`...... ......... City .......... 'l%Phone �'• 0zIContractor's Name .................: License d. Installation will serve: Res dente p Apartment House t} Commercial ❑Trailer Court ❑ Motel ❑ Other ................................................ Number of living units:...".1..... Number of bedrooms .�.�z.....Garboge Grinder ............ Lot S€Ye.......... ...:...........:............ . Water Supply, Public System and name .4.1-1 ..!-.:r.......,�.��L................................................ Pr#v� ... Character of soil to a depth of 3 feet: Sand ❑. Silt ❑ Cloy C7 Peat ❑ Sandy Loam ❑ Clay Loam [3 Hardpan 0 Adobe 0 Fill Mcterlai ............ if yet, type ............... ............ Onlw�i 1111 � �41M (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on reverse side.) NEW/ INSTALLATIONi (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT { 1 SEPTIC TANK[ } Size.... ..?... .. .. ............. Liquid, Depth ..... -.. . Capacity ...[SRR.. Type ... 4�67:z.7... Material ...................... No..Compartrnwts ....�.....:.. Distance. to nearest, Well ....................................Foundation ..�.�1............ Pro Line ..4....:_........ Prop. LEACHING LINE ' { ] No, of lines .t...�..':..... � ... Total Length ..`..�'t..� ......... Length of each line..........`?............ ................ 'D' Box ............ Type Filter Material .........:..........Depth Filter Material ......... ................................... Distance to nearest, Well ........................ Foundation ........................ Property Line ........... SEEPAGE PIT (J Depth �k'xq- n.11 Diameter ................ Number ......... ... —.......... .. Rock Filled Yes [g No 0 - Water Table Depth ..........:.....................................Rods Size . ..................... L Distance to nearest, Well .............. ..........................Foundation ......... Prop. Line .................... # REPAIR/ADDITION (Prev, Sanitation Permit # ............. .......:........:........ Date ............................ .} Septic Tank (Specify .Requirements) ...:.................. ...... ...................................................................................._.... Disposal Field (Specify, Requirements) ._....... ..... `� ...................................................................I........................ .............................................................................--•---..................._...................................................:........................................ 10row 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 Healih.Dlstrict. Heine owner or iitan- sed agents signature certifies the following- " + I ollowing:"t certify that in the performance of the work for which This permit ts issued, I shed! not ernploy any person in such manner as to become subject to Workman's Compe tion laws of California." Signed .......... Owner .. ,s ................................................................ By :................. ................. .. .... . Title ....... (if th r th n ow er1 FOR EP TMENT USE ONLY APPLICATION ACCEPTED BY .................. .. . _.�u ........ ......... C----..._..............: ....... .......... BUILDING`PERMIT ISSUED"......'.'-... .................. ADDITIONAL COMMENTS....................................................... ................................................. . final Inspection bye ...............�'.._....................... ............................................. ............ EH 13 2L 1-611 itev. 5M AN JOAQUIN LOCAL HEALTH DISTRICT DATE..,.,,..�......%...................... .DATE _ ....................................:..... : ?. ...r....... ............. ..._ Date .......�� .........._...._... 8/7h 3M