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FOR OFFICE USE.- APPLICATION FOR SANITATION PERMIT F ....................................:... -----...... (Complete ln Triplicate) PermitNo. ..................... 5''r Date Issued ......................................................... This Permit Expires 1 Year Frain 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. 649 and existing Rules and Regulations: JOB ADDRESS/LOCATION ............:.......--..............� .--- ? h �:—.. CENSUS TRII ACT .......................... Owner's Name .................... �.� .... ?.' ................. ......,_................................... Phone Address ,_...---- ........... . �? ..•�{g � ... ......__. City ............................ .. ............................... Contractor's Naive ..._._ ..►4�...riz -- .-_ ,--- t- -------..License # �-�f.•`f: r.3_ Phone - .6.�:. � .... Installation will serve: Residence [\Apartment House-0 Commercial ❑Trailer Court 0 Motel ❑ Other ...... . . ........... ------ Number'of living units:- .. .... Dumber of bedrooms ..------Garbage Grinder ... Lot Size _ . _ ``._.._ ?J-..__---.__ Water Supply: Public System and'name ---------------- --- _.._..—------- ------Private r Character of soil to a depth of 3 feet: Sand Silt E) Clay El Peat El -Sandy Loam E] Clay Loam ❑ F- _ _ .� Hardpan ❑ Adobe ❑ Fill Material .........--. If yes, type ...._...... . ------------- (Plot, -- _(Plot` plan, showing size of lot, location of system in relation to wells, buildings, etc. must be plated on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) `r PACKAGE TR f ATMENT1.J �SEPTIC TANK JA Size..-`---�--'*_.-_��- ---_-- - .--- Liquid Depth .._��............. Capacity ./LO�P!!I---.... Type __.................. Material.l!��,PFJ No. Compartments ._ ............... - Distance to nearest: Well wJ� ..........—Foundation ....- --? ..-__..._.. Pr p. Line ..-Y_....._........ [. RQ_ IIS LEACHING LINE [�}' No. of Lines Length of each line ...RQ............... Total Length .. --- ........._. 'D' Box Type Filter Material .&* -.....Depth"Filter Material _.. . .,-.___ --------------__...... 9w Distance to nearest: Well _.- ---------- Foundation �bE,__- Property;' Line -S_^.............. V .j SEEPAGE PIT [ ] Depth Diameter "�:'------------ Number ............................ Rock Filled Yes ❑ No (D- Water. Table Depth ........................ ---------- --------Rock Size ...... ................... Distance to nearest: Well ........................................Foundation _.... ......... Prop. Line ....... _------------ REPAIR/ADDITION(Prev. Sanitation Permit# .......... ............ Date --,.-----------------------_......1 I ill Septic Tank lSpecify Requirements) I Disposal Field (Specify Requirements) ---•----------------------------- ------------------_--- .......-- I--------------- ---....._.------- ----------- ----------- ..... ..-- .. -- --- -----• ........ ......... ........ ................. _....- ...... ............ -------------------- ------ = ........ ... (Dra'w existing and required addition on reverse sidel f, 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 [icon- 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 prson in such manner III as to became subject to Workman's Compensation laws of California." Signed _ ---------- - . ••-- Owner 0 By .... .. . _ Title i ....................... . .................................. (if other than owner) i ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ...., ! ......... .................................. DATE .r "I �?.'- ................ BUILDING PERMIT ISSUED ....... . ........ . .... AION MMEN _. , .fir _. _. . .s. Q.-_.:.. .................................... . ..............__._...-------...... --• ----------- ........... -----------•------- --------- t FinalInspection by: .._.. - .. .. - ..........................................•- --------Date .. - - ---- ....---•---•-•--....... i SAN JOAQUIN LOCAL HEALTH DISTRICT 4�