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FOR OFFICE USE: & APPLICATION FOS SANITATION PERMIT 0 8S Permit No: -.��---� ----- -------------------- -------------- (Complete in Triplicate) --------------------- ----------------------------------IN,-,.,_ Date issued - -----------------I----------- This Permit Expires ] 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: JOB ADDRESS/LOCATION �} ( ---- ---CENSUS TRACT -------------------------- .-- - 3QV_i-__._ ---.---'- ��- lJ------ --- ----- - - - Owner's Name ----- ----- ------- - -e--r-------------- ---- -- -------- t--------Phone ---------- Address ----------- City --- _ -------------------------- pp ---- --.License }�6 ------ Phone Contractor's Name --- -------------- # � . installation will serve: Residence'�fApartment House❑ Commercial ❑Trailer Court Motel ❑Other -------------------------------------------- Number of living units:______/-- Number of bedrooms ----�----Garbage Grinder -----------. Lo fi Size -____�Q�P - -------- -' Water Supply: Public System and name - ------------ ------------ ------- ---------- ----------- ------------------------ -----------•------------Private � Peat Sand Loam Clay Loam Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ ❑ Y ❑ i Hardpan ❑ Adobe-❑ Fill Material ------------ if yes,type _____--_._________________ {Plot plan, showing size of iot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: [No septic tankor.seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT { ] SEPT1C TANK [ ] Size____------------------------------------ - q P O , capacity _ Type ----------------- Material------------------------ No. Compartments --------- ------•----- y Distance to nearest: We11 ----- Foundation � � - Prop:Line - ------ g LEACHING LINE No. of Lines --------------------- -- Length of each line---------------------------- Total Length ------- ---_-------------- [ ] 'D' _ ----.------- Typ_e Filter M_aterial --------------------Depth Filter Material -------------------- ------------••--------- B -- r ll - Pro- er Line I Distance. to nearest: Welh_�_�______________'_-,Foundation---___ -'-:------------- px�'Y -� �r No i❑ 4 , I N m er --_ R it ed Yes ❑ E SEEPAGE PIT [ j Depth -------- Diarneter,,; u b �.- ---- ---- ---- ock.F I- Water Table Depth Rock Size ------------------------ ---------- ------------------------------------- _ Distance to nearest. Well ------------- ---`-o ndation -•--- 'Prop' Line _.. ------- f-------- C REPAIR/ADDITION,.[Prev. Sanitation Permit# .---- Date ---------- ------ REPAIR/ADDITION.[Prev. Septic Tank (Specify Requirements) ------ff---------- ---------------------------------------------------- ------------- ------- 1 4----------- -------- ----- r Disposal Field'-(Specify Requirements { �t :l l A - . v 4 ------ --•--------------------------=----------=------------------------------ i s -_i ___(Draw, existing and required addition on reverse side) 1 F hereby certify to prepared that I have this application:and that the work will be done in Joaquin'-),3accordance with San Joaquin` 6_' County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner orllicer _ 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 k as to become subject to Workman's Compensati.on•-laws-of-California.' _, Signed ___ -- ----- - Owner --- ------ --- ----------- ------------ B ----- -------- Title '. •----------- ----------------- ----------------- (If other n owner) - FOR DEPARTMENT USE ONLY APPLICATION ACC ED 8 - } =------------------- ------------------ ---------- '-. DATE -�1.`kr _"_7 z------------------ ------------ - i --------------- ------------------------=------- ------DATE ------------------------------------------- BUILDINGPERMIT ISSUED -- ---------------------------------------------------------------------•----------- ---- -- -------------- --------- ADDITIONAL COMMENTS ---------------------------------- ------•----------------- ----------- ---------- -- ------------------y--------------------�---------------'-------------- --------------- I-------- -------------------- -t __________________________________ _______ i ___r _________________________ i ____________________________________ _ -__ --------------- -___ _______ _ _________________ ____-.___.___-_--_______________________________ _____-___-___ ______________________ __ ___ Fino1 Inspection by: -.-- Date SAN JOAQUIN LOCAL HEALTH }DISTRICT. 1 ' E. H. 9 1-'6$ Rev. 5M --