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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -- Permit No: (Complete in Triplicate) , -----.....I----------------------------------------------- ------------------------ This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a per 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 .__ ....... TRACT _________________________ Owner's Namee p1 ----------Phon Address �&�� L- 111-tiS_ f City -- ------ ------------------- Contractor's Name ----- _-' ��-------License # T. Phone Installation will serve: - sidence Apartment House❑ Commercial ❑Trailer Court I❑ I ---- Number of living units:....(__._ Numberofbedrooms __� Garbage Grinder ____________ Lot Size _____.�___��-__-=...:...:....... Water Supply: Public System and name -------------------------------------------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay A Peat❑ Sandy Loam ❑ Clay-Loam 0 Hardpan [] Adobe'❑ Fill Material ------------ If yes, type ____________________________ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit-permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC`TANK'[ ] Siize__________ _ __ ------------------------ Liquid Depth __d_ �___,_____ Capacity Type !;; j6 ll " aterical____C ___ No. Compartments ---- ------ __Dv � ,l Distance to nearest: Well _._____ _r__ ____________Foundation ___ ___..__ __-_ Prop. Line ___IS-- -- -- / 4(LEACHING LINES [/] No. of Lines -------!-------------- Length of each Iiin.e�)_(__3,6-�_-_ Total Length ___ ��Yfi�pFp< 'D' Box __ Type Filter Material fig--Depth Filter Material ___��!___________......x-------- J Distance to nearest: Well __/010__ ______ Foundation -------------- Property Line -- 7------_____ d SEEPAGE PIT [ ) Depth ____________________ Diameter ---------------- Number -------------- ------------ Rock Filled Yes ❑ No i❑ ID Water Table Depth ------------------------------------------------Rock Size ------------------------- •---- 11 Distance to nearest: Well ----------------------------------------Foundation ------ Prop. Line -----------_---------- p REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date ----------------------------------I Septic Tank (Specify Requirements) ---------------------------------------- C) Disposal Field (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------------------- Q , ---------------------------------------------------------= --------------------------------------------------------------------------- ------------------------------------------------------------------ ------------------------------------- ------------------- -------------------------------------------------------------- .(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 licen- 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 as to become ct to Wor on's, mpe tion laws of California." Signed ------ Owner By -------- --------- Title ---- (If other than ow r) FOR DEPART T ON).Y / ® rte APPLICATION ACCEPTED BY ---------`-------------------- - ----------- ---- ----- DATE ---f7.-=pk�'�-J BUILDING PERMIT ISSUED ----------------------------------- ----------- ------------------- ---- ---- -------DATE ------------------------------------------- ADDITIONALCOMMENTS --------------------------------- ------------------ ----------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------- - - FinalInspection by: -----------------------------------------------------------------------------•----- -------- - -- -------------.Date ------------- ---------- ---- I SAN JOAQUIN LOCAL HEALTH D ICT E. H. 9 1-'b8 Rev. 5M