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FOR OFFICE USE. APPLICATION FOR SANIT1►TION PERMIT 73.33 ------------ =�-`------ � _y Permit No- -------------------- ---------------------------------------- .�I� {Co`ntplet'e`in Triplicate) ---- --------------------------- I!-_-- Tris Permit Expires 1 Year From Date Issued Date Issued _-5---------------- --pp Application �s hereby mad ---- - - - ----- ---------= --- .I y':.,,4 , A I� y e 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. //IV fA [--�t---'s-�---------- CENSUS TRACT ---{---------------------- ' Owner's Name --------- kms --------- `W =-_=_= - ------------ ---- --------------------- one - ------------ - ---Ph3 r ! Address -------- -t--------------------------------------------------------' --"- ----------•--. Cit J -��/'- nom -`= ----- -----License # --7-7Phone -- �7__ � Contractor's Name F f - r- r - Installation will serve: Residence Apartment House❑--Commerciale:❑Trailer Court 10 Mote! ❑Other -------------------=------ 1. I Number*of Elvin units: --.�`--._ Number of`bedrooms --,9?,--__Ga'rbc e Grinder _VO Lot Size -7�2 r_ 9 _. Water Supply: Public System and name ---:=-------------------- -------------------- ---_-------------------------------------------Private ❑ , Character of soil to a depth[of 3 feet: x Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ----- ------ If yes, type ---------------------------- ' (Plot plan, showing size �f lot, location of system in relation to w_ ells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: INo septic tank or seepage pit permitted if public sewer is available within 200 feet,) Il PACKAGE TREATMENT [ I SEPTIC TANK.[ ] Size-------------------------------------------- -- Liquid Depth ---------------- --------- C1 ----- Capacity -------------------- Type -------------------- Material---------- -- -------- No. Compartments ---------------1 .... S s 11, VJ Distance to nearest. Well ------------------------------------Foundation ---------------------- Prop. Line ----------____--.----- LEACHING LINE { ] MID. of Lines ------------------------ Length of each line---------------------------- Total Length -----__-_--.-_-_.------._--- Z •DI Box ------------. Type Filter Material --------------------Depth Filter Material -------------------------- --------------- Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line ------------------- r SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No 13 i Water Table Depth ------------------------------------------------Rock Size -------------------------------- i Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------- Septic ---_--_-_--- __-_-----_-__-__-___) -r Septic Tank {Specify Requirements) = --------------------------------- ------------- t - t Disposal Field (SpecifyRequirements) f � .�T � .Fr rel?'------------ - ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I ------------------ ------------------------I`--------------------------------------------------------------------------------------------------------------------.------------------------------------------- (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, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or Iicen- i 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 _f as to become subject to W'orkman's Compensation laws of California." Signed ---------- - ----- ------------------------------------------------------ Owner - BY ------ - -- ----'----- - -------------------------------- ----------- Title ---- ------------ '. (If other t an`owner) I� F R .DEPARTMENT USE ONLY a APPLICATION ACCEPTED BY -------- --- -- ---- ---•----------------------------------------. DATE -----'� - -------------- i BUILDING PERMIT ISSUED, ---------- --------------------------------- -------------=-------- ---DATE --------- ADDITIONAL COM TS ' --f-�'t1 -------- ---- ------- - -------- = - --- ------ / ------------ �-, -------�"� ,� - -r !� Fina! Inspection by-. - .: "' -------- Dy"c N AQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'h8 e . I�