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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------------------------------------------------- Permit No. - ------------------ {Complete in Triplicate) ------------------------------------ ------------- Date Issued_,//=1 = , -----_---------------_--------------- This Permit Expires 1 Year From 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 compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION- ' , 3 --- --------------- CENSUS TRACT = - Owner's Name -------- -------------- ----Phone ----------------I--- ---- --------- Address _ 1 --` -"`--- r ... City ��. - _ Zip- _ µ Contractor's Name - --•-Gc - .c'0 ----License #__ 2 8� Phone ------ -- -- - - Installation will serve: Residence [►/ Apartment House.❑ Commercial ❑ Trailer Court ❑ Number.of living units:__---._�-_._Number Motel ❑ Other.--;... _- _-.-- _... a 5 of bedrooms:-----Garbage Grinder._._...----Lot,Size....-Z-''�---`_- ---------- Water -------------- Characterofsoil to a depth of 3 feet: Sand -Silt .-- ---- ------------------- -- ------ Private Water Su I Public S stem and name.............. t ❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam [� Hardpari ❑ Adobe ❑_,--Fill Material-- .. -1#yes, type----------------- -----_-..-..- (Plot plan, showing size of lot, location`of.'system in relation to%wells; buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank'.o�se age .pit permitted if public sewer is available within 200 feet,] � 1 r ; PACKAGE TREATMENT [ ] SEPTIC TANK [ .' Size-$----- -1.� --- --- ---------- ------Liquid Depth.---L-4- ---------------�j Material...: .... ...... .. .. .No. Compartments--------�------------------s--- Capacity---��Q�------=TYPe-.= --- -- =------- -- - Distance to nearest: Well-`.=-� ----� --- ----_-Foundation..------)-Cl--------------Prop. Line LEACHING LINE [ Na. of Li'nes.:.._._.__,,_. -- --,.-_.Length of each line-----------7Ro, - ------Total Length.-:__..f. p---------------------=-- 'D' Box--1. ;--Type Filter Material------tMI— ----.Depth Filter Material-----------]_�-------------------- ----------------------------- Distancetoneare.st: Well------l- c)_I`-.-:----.Foundation.-.--._[.a_t...-------...Property Line----�0------------------------- SEEPAOE Fi [ ] Depth----�2_-_-tiDlama#er.: __.lt-C- ..Number---:---- -------------= Rock Filled Yes.[ � Na❑ Water Table Depth-------------------S-2----- ------- = Rock Size. �__ - -,------------------- t Distance,to nearest: Weil-.....----1--11>-4P.--I------------------- Foundation__-_-._[__C...!---------Prop. Line----. -------- REPAIR/ADDITION (Prev. Sanitation Permit#---------------------- -------- ---------- --------Date---------------------------------------------1 Septic Tank (Specify Requirements)—.,='---- =- Disposal Field(Specify Requirements)---------- --- ---------------------------------------.-.- ( - ------------- -------------------------------------- -------- ---------------------------- --- ----- ----- - ' =------------------- ------------------- -- -------- ----------- ----------------- ---- --------------------------- . (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 licensed agents signature certifies the following: "I ceftify 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.'.' . Owe w Title---- -------- ..... tk - (If other than owrier) f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY = ------------ --- DATE. - -- ----------- ------------ DIVISION OF LAND NUMBER:. = --------.DATA_ --- i ADDITIONAL COMMENTS --- - .. - ----- - --------------------------------------------------------------------------=----------------------------------------------.---------------- --- ------- iFinal Inspection b + .. -� t LL ---------- Date... -._.9 �r 7 . - .. I EH is 24 SAN JOAQUIN LOCAL HEALTH DISTRICT r&s 2ie � Rev /�e 3M