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..FOR-OFFICE USE: APPLICATION FOR SANITATION PERMIT / No /fes ..,..w... .. . .. _.-_�....... � --.••- Permit J - ----------- ----------- --------------------- ------- (Complete in Triplicate) 7 ---------=---------------------------- ---------- --- ---- p Date Issued ------------- 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: ti Mr �jC ENSUS TRACT - -------- 1 ---------A a 708 ADDRESS/LOCATION rOwner's Name _ --- - �----------------------------------------------------- Phone Address �' � /1 ' --- ---- ---- -. city '� a ' ., �- ---- Contractor's Name _.eci -Q- -_.License# �/��,-ate . Phone ___________________-.__-- Installation will serve: Residence ❑ Apartment House❑ Commercial :❑Trailer Court Motel ❑Other ' -------------- Number of living units:__'__- -- .Number of bedrooms ___'___Garbage Grinder .--__.__.__. Lot Size _-_-_______ Water Supply: Public 5ysfiem.and;name ------------ ---- --- ------------------------------------ ------------- - ________-Private (_'f ' Peat Sand Loam Clay Loam ❑ ` t Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ ❑ Y t Hardpan ❑ ❑ Fill Material ------------ Adobe if yes,type ------------ (Plot plan, showing size of lot,location of system in relation to wells, .buildings, etc. must be placed on reverse side.) ' I seepage pit permitted if public sewer is available within 200 feet,) � NEW INSTALLATION: (No septic tank or ! f SEPTIC TANK Size-��__.X_�/___�'__ ------------- Liquid Depth ---44. ---------,-.- � PACKAGE TREATMENT [_] � , j �) • Material_ ------- No. Compartments --__ ---.-------- 1" 1 Capacit i �.�-�_� --•-- TYp -- -- --- - r i Distance to nearest: Well --------- -----------------Foundation _.__1p------------ Prop. Line ---S-------•-----•-- I LEACHING LINE [�No. of'Lines Length of each line--____-'--p ---------- -- Total Length ___� -------------=---'r 'D' Box _ _: Type Filter Material __ __ •_------Depth filter Material -----l_-"___________________________._.._ . -o ------V O- ----------- Property Line ___- --•--------------- Distance to nearest: Well _______.�`"_P_�_______ Foundation p tY � . j SEEPAGE PIT [ ] Depth ---- Diameter ------------- -- Number --- ------------------------- Rock Filled Yes ❑ No .� !- Water Table Depth __ Rock Size --------------------------------Distance'to nearest: Well ----------------------------------- ---Foundation -------------------- Prop. Line ---------------------- s REPAIR/ADDITION(Prev. Sanitation ) , Permit# ----- --�------- ---------- --------- - Date - ---------- - k ---------------- .� Septic Tank (Specify Require 4ents) ------------------- ------- --------- ---------- ----------------------- ------ ----------------- r Disposal Field {Sp cify Requirements) ------------- ------------------------------------------------------------------------ --------- --------------------------------------------------------------------------- --------------------------------- - ------------------------------------ a- -----Draw existing and required addition' ----------------------------------------------------------------------------------------- - ditioon 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 liven - sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, t shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." I B SignedOwner U ------------ Title --f~a( / ----- - ---------------------- (lf other than owner) FOR DEPARTMENT USE ONLY I APPLICATION .ACCEPTED BY _1_ - - - - - -- - - - --- ----------- ------- --- ------------ --------------- DATE----------------- ----- ----- ---- ------ ---- ------------ -------------- _ _------------- BUILDING PERMIT ISSUED ---�� - -------------- --------------DATE ------------- ----------------------------- - - ADDITIONALCOMMENTS ------A------------------------------------------------------------------------------ -------------------------------------------- I -------------------------- ----------------------- -- -------------------- ----------------- -------------------- ------------- -------- ---)- ----- --------- ------------ -------------------------------- {�' - — !J ns action b --------------------- Date SAN J AQUIN LOCAL -------------------------------------- SAN ._- Fina l - I HEALTH DISTRICT E::H. 9 1-'6B Rev. 5M