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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 5 rd Permit No. _��- ' ----------------- --- ---- � ------ m;. 2 {Complete in Triplicate} Date Issued This Permit Expires 1 Year From Date Issued l the work Application is.hereby made to the San Joaquin Local Health DistrictrOrdinance permit to construct and ins and existing Rulestwind Regulations rein described. This application is made in compliance Y - CENSUS TRACT -------------- ----------- � � ---- - -.-�-'-,--JOB ADDRESS/LOCO G �hPhone Owner's Name ------�-Q-ma' ------- --------------------------------- ----------------------- Cit, Address ------ /V -t9- Contractor'srNdme -.__ - � '--------------------------- -------License # ----- ----------- ------ Phone ------- ------------------- i Installation will serve: Residence VApartment House°❑ Commercial ❑Trailer Court Motel ❑ Other ----------------------------------- -------- rooms c r Number of living units:_--.--- Number of bed -__--Garbage Grinder/��--- Lot Size - --� -- -��-� ------- - -------- /- Private ❑ N Water Supply: Public System and name -- _ 1` +t - = Character of soil to a depth of 3 feet: Sand❑ Silt❑ Gay ❑ Peat❑ Sandy Loam ❑ Clay Loam :❑ Hardpan ❑ Adobe XFill Material ------------ y If es, type --------- ------------------ i buildings, etc. must be placed on reverse side.) -(Plot plan, showing size of lot, location of system in relation to wells, NEW INSTALLATION: iNo septic tank or seepage pit permitted if Public sewer is available within 200 feet,) f p� ` f Liquid Depth �� ---.--.----- V i PACKAGE TREATMENT [ I SEPTIC TANK ( Size- --1 X, b Materia!�pPJ� ---- No. Compartments ------ ----------- 'Capacity� - ---- Type ` `rFoundation Prop• Line _._ k Distance to nearest: Well ---_ ----------------------------- � -__- Len th of each line-_�a-------�--�-. -- Total Length -46 Q'--�------ ------- LEACHING -LEACHING LINE No. of Lines ------------------- g D' BoxIfl( Type Filter Matenal�� - -Depth Fitter Material - Pro per Line -- --------------•----- i Distance to nearest'. Well _--- ---------` foundation __�" ------ ------ p tY f j� Rock Filled YesA No I❑ i Depth /'f?.1Clt�.K Diameter s+14 X/p---- Number ------------------�- r� F SEEPAGE PIT [ ] p - ROCk Size -- ------------------ �. Water Table Depth -------4�- --------------- 0 Distance to nearest: Well .....r --- ------- -=------------- Foundation _- �® ------ Prop. Line - _- __.__•_---- REPAIR/ADDITION(Prev. Sanitation Permit -----------------------------;--------------- Date ---------------------------------- --•----1 Septic Tank (Specify Requirements) -------------------- - - --...---------- Disposal Field iSpe i e uirements) ---/ r i = --------� -in t- . L csf� /`�'P --------- ---- -- - - - - - -------------------------------------------------------------------------- --------------- ----------------------- - - -------------------------------- -�"--- �� (Draw existin- -- - --g an- - -d 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, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Horne 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 shah not employ any person in such manner as to become subject to Workman's Compensation laws of California." I -- Signed ------ ------ ------------ ---------------------------- ----- -------------------------------- - Owner ------- ---------------- Title ------ Or -- ------------- (if r than owner) FOR .DEPARTMENT USE ONLY l . - DAT! -- APPLICATION ACCEPTED ay _ � DATE --------------------------------- i BUILDING PERMIT ISSUED ------------------ -------------------------------- --------------- ADDITIONAL COMMENTS - ' '''z1�� `- . --- ----------- -- ------ -------------------------------------------------- ------------ ----------------------- ------------ r. l-D - - --- --------------------------------- - ---------- ----- ---------------------------------------------- - --- .Date --- -- ------ ------ Final -J- --- ---�- - - ---- ------- --- ------- -- - ---- - ------------------------------------ Final Inspection b � ; * SAN JOAQ IN LOCAL HEALTH DISTRICT I t_ E. H. 9 1-'6B Rev. 5M