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FOR OFFICE USE: .._..._. APPLICATION FOR SANITATION PERMIT 3 ; ........................................ Permit No. ..7�•- (Complete in Triplicate) 3 .................................................. .... r t This Permit Expires ] Year from Date Issued Al,Da Issued .. 7� c . i / ��yam- �/ Application is hereby made o th -San o�bin�l'Fic�afth Ctrict or a pe mitWtc Zuc�nd�install the work herein described. This applicatio s made in compliance with Caynty Ordinance a. 549 and existing Rules and Regulations: JOB ADDRESS/LO .. ------- ENSUS TRACT ... ..................... �. Owner's Nome ..... one...........:...:...................... Address _.._.....45 � � . ...... .......-••-•• City ................... ............ ..... • -•••--.....,.. ... .. Contractor's Name �77tie License # ----- hone Installation will serve: Residence 14-Apartmen ouse,6 Commercial ❑Troller Court 0-, Motel ❑ Other ................... ..................... Number of living units:_,__...... Number of bedrooms _0........Garbage Grinder ----------- Lot Size .. l ...... ..............:.. 1 Water Supply: Public System and name .....................................Private ❑ Character of soil fo a depth of 3 feet: Sand❑ Silt❑ Clay ❑ eat❑ Sandy Loam ❑ Clay Coam 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 side.) l NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is.ovailable within 200 feet,J PACKAGE TREATMENT [ SEPTIC TANK f ] Sia® _ _ Liquid Depth .f Capacity -4b . .... Type .�,.�........._ Material__�'..,�-�----..._. No. Compartments ---_ ___........._ Distance to nearest: Well .-. ...............�--••--=---•-•-------Foundation .�-��-------------• Prop. Line -�--------------•-. LEACHING LINE f No. of Lines ------------ /.................... Length of each Ilne... l 'J ........•--.. Total Length .l._G _....:..:..... 'D' Box __-- _-._. Type Filter Materia( ....................Depth Filter Material ../_.c _..........-_-........:......, Distance to-nearest: Well ........................ Foundation -------------------=---.- Property Line ....:'...: ::=: .. Rock Filled —Yes• o E 1 : .Depth .(.�; :��Diarroeter .................Number ------------ -- - C�+"�N ❑ Wote�able pth. :. •.............. ._..... ----------Rock Size ` ..% , Distance~to nearest: Well .. . . ... II .......---•-••--�--•...................Faundation -------------------- Prop. Lina -••-•--•---•-•--••- REPAIR/ADDITION.(Prev. Sanitation Permit+# :} ,� Date-. -•' ' 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, StatiCaws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or !leen- sed agents signature certifies the following: . 43 "I certify chat in the per€ormance of the work-for which this permit is issued, l shall not employ any person in such manner as to become subject to Workman's Compensation laws of Califlif nia." Signed ...... :,....= .. . ............ :..Owner BY ............... .... .... ... � gid'; -.._.._._..- ----- = • Title _..__.._.... ................ ,' l (I a he t n ovine DEP RTMENT USf ONLY Y { APPLICATION ACCEPTED BY . `--------•-----=---------- DATE ...... BUILDING PERMIT ISSUED ................ . . .............DATE ... . _.. .................. ....-- ADDITIONAL COMMENTS -----------------------------............................ ------------------------------------------------ ._.. ........ . -.... - --N.........I.._... y ..:•.. •--•.............................._.._.. .............. ............... --- - - -J..__... .. i .-................... Final Inspection by: ... :''ll... /f II ""J""' �..__,..... Date .�..� �: ... ._. ( i SAN JOAOUIN LOCAL HEALTH DISTRICT E:H_13--94-1,'68 Rev:-SM. 7/ 23-M s—