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FOR OFFICE USE: APPLICATION FOR ,SANIT TION PERMIT �� /ate Permit No. _--__ ----------- --- ------------------------ ------ ------------- ------- (Complete in Triplicate) Date Issued /� ---------=------------------------------------- ---•-_ _-- �.: r-, � „ This Permit Expires 1 'Year From Date Issued - nstruct and l the work it to co Application is hereby made to the Son com compliance Local Health lth Dtytrict for Ordinance Nom549 and ex sti g Rules tand Regulations, described. This application is ma i? a , ' CI=NSUS TRACT 1 __Phone ------------ l JOB ADDRESS/LOCATION - -- - - - - �'-Y` " - Owner's Name �__ __-_ _"---------------------------------------'---- ,< City --- ------------------ - - ---- I. Address = Contractor's Name _.__" =-----.License #CGS , Phone - Installation will serve: Residence ,Apartment House❑ Commercial :❑Trailer Court ',Q Motel ❑Other ------ ------------------------------------- ------ Number of living..units:___2-i*_—.--.••Number of bedrooms- --------- Garbage:Grinder.____—__- -Lot Size = Private ❑ F - - ------------------ --- -- -- - ------------------------------ - --- Water Supply: Public System an name ----------------------- ---- ----------}- Character of soil to a depth of 3 feet: Sand'®;] Silt❑a '`Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ 1 t. Adobe' FilI Matbrial-_. _-___"if yes,type -`----------:-------------- - k� Hardpan ❑ ❑ i (Plot plan,1 showing size"of lot, location-of system in relation to wells, buildings, .etc. must be placed on reverse side.] NEW INSTALLATION: (No septic tank or_seepage pit permitted if public sewer is available within 200 feet,) �SEPTIC`TANK' Size---------- --- ----------- - ----------------- Liquid Depth -----------------•-------- PACKAGE TREATMENT [ `[ _ No. Compartments ------------- Ca acit Type -------------------- Material- p Type Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line -------•-----=-:• y, - - Total Length LEACHING LINE [ ] No. of Lines ----------------------"- Length of each line.-___----------------- - De Depth Filter Material ________-_--------- I - 'D' Box __ --_ -- Type;Filter Material ------------- P t L+ \ , s --- Foundation --------------- Property Line -------•-------- Distance to, Well __-____-.------_"--- Depth e ' t�� Diameter ----------------- Number ---------- ----------------- Rock Filled Yes ❑ No :O , SEEPAGE PIT [ } P - -. r= If Rock Size - .Table_.Depth..------------------------------------ -- ---- Distance to nearest: Well -.______________________ --•---------•-Foundation -------------- ----- Prop. Line __. I REPAIR/ADDITION(Prev. Sanitation Permit -------- Date ----------------------------------) Septic Tank (Specify Requirements) ---- ---------------------------------- -----------------------------------------------------;------- :,. Disposal Field (Specify Requirement ------------------ --------------------- -- -- ----- ------------------ --------- -- __ _____- _ ,f --- - - ----------------------------------------- (Draw existing and required d Iitlon on reverse side) C 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 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 becom u ct to Workman's Compensation laws of California." - Owner Signed - --- - -- ---- ------- - �( -- Title � -�- -- `�--•---------------------------- I other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ - -- - - rt DATE _1�_-�.��-,P--------------- - - - ----------------------------------- -- - BUILDING PERMIT ISSUED _._ -------- -------- -- -- ------------------ DATE - ADDITIC?NAL COMMENTS ------- -------------------- -=--------------------------------------------------- ---------- ---- - ------------------------------------- ' ------------------------------------------------ ------------------------------------------------------------------------------ -------- ------- --------- - Date�s2 --- -------------- ------- - -a- --- Final Inspection bY_ __ __ _ _ _ _ ___ ___ _ _ - --------- -------- -------- - SAN JOAQUIN LOCAL HEALTH DISTRICT f E. H. 9 1-'b8 Rev. 5M