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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ..................... .. ................ ............. .... (Complete in Triplicate) IIDate issued .-�:-'�~�.••- This Permit Expires 1 Year Frons Date Issued Application is hereb made to the San Joa uin.local-.Health.District,fora 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: .. �. ...... L � .1.�/......CENSUS TRACT .......................... JOB ADDRESS/LOCATION �.... yy�. ... Owner's Name ---- .: Phone .... ....................:........ ## ......._.-- . city .� ....... ...... i Address . .//.�- c_.._..... f � f ,ls^ i _P�.. --fi�rr Phone '- f I el License #p / ... Contractor's Name ----... _.---�_ �. �e'�•-�..............'--------••- installation will serve: Residence,gApartment House❑ Commercial❑Trailer Court ❑ It Motel ❑Other`.:-.......................................... • Garbage Grinder/_ _ Lot Size �lf' ::::.......•............ Number of living units:._,_...._ Number of bedrooms' ......._. 9 / Water Supply: Public System and name_ .............................. .....:-.- ------•-•-------•---------- ...........--.... Private Character of soil to a depth of 3 feet: Sand❑ _Silti[3 .Clay ❑ • Peat❑ Sandy Loam�j Clay Loam ❑ Hardpan ❑ Adobe❑ Fill Material ............ If yes,type ---------•.----_--•-•• (Plot plan, showing size of lot, location of. system in relation to wells, buildings, etc: xmust be placed on reverse side. IT NEW INSTALLATION: (No septic tankfbr seepage pit•permitted if public sewer is available within 240 feet,)`. .;quid Depthff................... PACKAGE TREATMENT SEPTIC TANK . O Mteridlld .'._... No. Compartments �........... Capacity .......... Type .? U ' Distance to nearest: Well _..•....Foundation ..1.........-_` : Prop. line .. -�`�+�...._...... Len #h of each line .47 t Totat 'length .�ar •=• LEACHING LINE j No. of Lines - ...---•-----•- I� r ' pp . Depth Filter Material 2__ .. ... .......__:` 'D' Box I C 7... Type Filter Maternal` ' p Foundation _`A............... Property Line ......-------•••• Distance to nearest: Well __; ��`•___--_• /// _--__ Diameter �/. Number " �' ---- Rock Filled Yes p No Q }p SEEPAGE PIT ;�j Depth = & Iff /� !� ...................Rock Size , .. Water Table Depth �, ' .... -�.... `t �� ... Prop. Line . . Distance to nearest: Well . p......•-----.....•--..Foundation ... ...__....... ...... Date ..................................I REPAIR/ADDITION Prev. Sanitation Permit!# Septic Tank (Specify Requirements) ............ .. ..... ..__..........------._.... ..•---- .................. Disposal Field (Specify Requirements) ............. ...............---------•.............----............................. ............. ........... ----•------••---------......------.....--•-----=........ ---------------- ._....... -------------------------- .................... -------- --•- •- --- -and- - - -----•• -- - (Draw existing required addition an reverse side) •• • I hereby certify that I have prepared this application and that the work will be done in�occordance 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 any person'in such manner as to become subject to Workman's Compensation laws of Californla." Signed __......---•••--- ••. ..................... . Owner f B n ..:.. : Title . ,... ---------- Y ........................ --- ' {I er than owner) FOR DEPARTMENT USE ONLY-- PT NLY"'"``" APPLICATION ACCEPTED BY .. ... ....... ..:............................................................... ....... ... DATE .....7.n- .�..�5 ....... BUILDING PERMIT ISSUED ...•' ---- -•-------••-----------•------- ------ ---•---•-:............. ........... . .DATE - ... - ..:.......... ADDITIONAL COMMENTS ..............-- � • -�•• ._._.................................� ....�........._.... ... ............._....._..._.....__._..__.. .,.......... • ...=.. .. _ '� >... Final inspection by: . . .._ �---- •---•-----•------- ----.........Date _.../..-�,.�'..��,,��..-----...-- SAN,JOAQUIN_LOCAL' HEALTH DISTRICT s" _