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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT /-/ - - .r* Permit No: .---(-_1_—----------- .�► (Complete in Triplicate) --------------------- ---------- --------------- ------- This Permit Expires 1 Year From Date 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 madejin com liance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LO TION ��-��- --- --- ---- '- - � --�� -1�'�----------- ---<-�-0-�-------------CENSUS TRACT --- -- -,__..__....-- Owner's Name .'.!!'- (J '_r_ + ----- ----- - Phone --------- Z s � — _ ._ I Address -------- - -- -=� ---! l /L City --- -'`=�-------------------------------------- f Contractor's Name -----�--.-_'_ y - �, -- � r�P,---License # ------------------------ Phone i Installation will serve: Reside nce ❑ Ap rtment House❑ Commercial []Trailer Court i❑ I I Motel ❑ Other ---- ------ ------- ------------------- Number of living units;---._ Number of bedrooms ..Garbage Grinder l Lot Size .� ..__ -f--------------------------- -----••---- Water Supply: Public System,and name -------------------------- ---------------------------- -------------------------------------Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type ---------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse I side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT SEPTIC TANK Size__` F� fr--------------- Liquid Depth - __{ .:____,_. Capacity 1-211.04------- Typej'9JhtZr"MPlal terial_01;1j .._. No. Compartments ----- --- ------- Distance to nearest: Well "--"_--___-__-_."__Foundation ------/1-------- Prop. Line _--_-- LEACHING LINE No. of Lines -------I--------- -- -- Length of e h line------ ------- Total Length :--- - .P ..:_...__V \J 'D' Box .---- ------ Type Filter Material 1' 129 epth Filter Material - - ----------------------- -'.. -•- + -�O i , Distance to nearest: Well __/_--------------------- Foundation -, -- ______-__.__ Property Line. SEEPAGE PIT i f [�; Depth �-�..__. -_ Diameter - -..- -.. Number --------- -------- Rork Filled Yes � No i❑ € .. :.t s l Water Table NDeptf = Rock Size ° {Distance to nearest: Well _---�_ ________'�______--_-_.Foundation __ '®-__-_--- Prop. Line ....-�� 4,Y .......... REPAIR/ADDITION(Preva Sanitation jPermit --------- ----'&---------------" " Date "._---.._-____-__-_.__-__-.._._.__} --------- r Septic Tank {Speci#y Requirements) - _ --------------------------------- Disposal Field {Specify Requirement s) ------ --• �' ° - --- - '- irr ----------------------- -------------------------------------------------------I----------------------------------------------'------------------------------------------------------------------------------•------------- (Draw existing'bnd 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 k 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 any person in such manner as tot to k Co en ati aws of California." Signed kcfs /Y� ---------------. - By ---- ---------- -------------------------------------------- -- w � ='`//a ----------- Title ------------ U (!f other than owner) FOR DEMT USE ONLY APPLICATION ACCEPTED BY - - DATE BUILDING PERMIT ISSUED ---------------'-- --------------------------'------------------------------------------------------------ - ------------------------------------ DATE ------------------------------------------- ADDITIONAL ------------•------------------- -.ADDITIONAL COMMENTS ------------- ---------------- ------------------------ ----------- ---------------------------------------------------- -------,-•---------------- --------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -------------------------------------------- ---------- ---------------------;--------------------------------------------------------------------------------------------------------------------------- = - .} Final Inspection by: 9r�=---------- ------------------------------------- -- --------------------------Date .l- l--�_-- -" SA JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M.