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r `—FOR OFFICE USE: 1 ` _ APPLICATION FOR SANITATION PERMIT ........................... ............... V 2 iCornplete in Triplicate) Permit No./r..:::J1:3--- ........-- This Permit Expires 1 Year Prom Date Issued Date Issued lQ_.f�:7_$" F 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/LOC TION ..-... . • . ... V.-CENSUS TRACT ...................... Owner's Name ------ .1 .......................... one Address ........ ita` ._._....._ �!..... ................:city ... ! ..: Contractor's Name --------- ...- . ..._ .License# --- ------ Phone Installation will serve: Residence fl Apartment House] Commercial O Traller Court 0 Motel ❑Other.............. Number of living units............... Number of bedrooms Garbage Grinder Lot Size f{ -- ----•............................... Water Supply: Public System and name ......................................................... _._._.Private�. ................................. ......... Character of soil to a depth of 3 feet: Sand RJ Silt Q Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ 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.} n NEW INSTALLATION: (No septic tank or seepage pit ,permitted if public sewer is available within 200 feet,) , PACKAGE TREATMENT I ] SEPTIC TANK Size------ - .... --_--- Liquid De U Capacipth ty — ---- Ype � a Mater€al... "� +�__ No. Compartments Distance to nearest: Well ....../--qp-.....................Foundation - Prop. Line _.UIs. f LEACHING LINE , I i .. Length of each fine...__.19.--- Total Length No. of Lines .. i� Jfi 'D' Sox YO!S--- Type Filter Material ! ii ......--_--•._......Depth Filter Materia! .._...l.��.._._.....•-----•_,...--- -...... Distance to nearest: Well .. _b........:....... Foundation .... p...._..._.... Property Line .......ate.................. SEEPAGE PIT ( Depth ---------- -------- Diameter ................ Number ...-..-..-.---_--- -- ..._ Rock Filled Yes Q No (3 Water Table Depjih ................Rock Size Distance to nearest: Well •_-.............................. .......Foundation ..................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ........................... . Date � 4Septic Tank (Specify Requirements). .._..•-•---. -••... ....••......•••......... r, ---•-•.._..... -•----•--•------...............--•-•-•......--- ,:.Disposal Field (Specify Requirements) ................................................... ------------••- --------------•-------------- (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:Dlstricf. 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 subject to Workman's Compensation laws of California." Signed -- „�-` Owner By ......................... ............ Title (If other than owner) ----- .......................... i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ -- ------ -------------- DATE - BUiLDING PERMIT ISSUED ----... - .............. .....DATE ....._------------------------- ADDITI NAL --- COM OM ENTS d[ -------------------------------------------•-- ...--------- . ............ :::..... Final Inspection by. _ ----- Date .. .. ..1� =.f --. .. . . . ..•.......................................•-----•--•-•--------• �...7�....- . EH 13 2 16 Rev• SAN JOAQUIN LOCAL HEALTH DISTRICT /7h 6 3M CAfLl- _ .. . .