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FOR OFFICE USE: O9x/S APPLICATION FOR SANITATION PERMIT --------------------------- -----------------`,` G ''(Complete in Triplicate) Permit No. _�_��_--- --------------- ------- This Permit Expires i Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District foraermit to construct and P install the work herein described. This application is ma �com�lia, t�F out O� ance No. 549 and existing Rules and Regulations: ��' �� JOB ADDRESS/LOC TION $6 _ __ � � -CENSUS ,l - -- - E - -- - -----NSUS TRACT -��---------------- Owner's Name ----- 4 _ _ -. Phone 144 " jr ,�t� -- - - ----- Address � e -1------ -------------------------------- City Contractor's Name ---- - -------------•---------__---_ Li6 cense # - Phone --` V•-- Installation will serve: Residence-�b Apartment House❑ Commercial ;❑Trailer Court ❑ Motel ❑Other -------------- Number of living units:------------ Number of bedrooms _�----_-.Garbage Grindertx�►'. Lot Size 10 Water Supply: Public System and name ______________________ -------------------------------------- Private ] ---------------------------------------- i -Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Gay ❑- PPea 8ndy Loam j__ Clay,Loam;❑_ Hardpan ❑ Adobe ❑ Fill MCit __>------ -- 6 s, 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 i pub 'c sewer is available within 200 feet,) I K ] 0 PACKAGE TREATMENT [ SEPTIC TAN SiSize-- - ------------------ ---- Liquid Depth -- ----------------------- Capacity/0 -------- Type _4Pi!e_ Material_____-____- No. Compartments __ - . _ Distance to nearest: Well11 1 r fi ----------------------Foundation _140--- Pro Line -_ LEACHING LINE No. of Lines ---- Length of each line--- --- Total Length VCS- .-A-Vv 'D' Box �--_ Type Filter Material '--------Depth Filter Material Distance to nearest: Wel! '___•_--_ Foundation _ + _-- -__--._-_ Property Line a ..-----------.------ SEEPAGE . ..SEEPAGE PIT [ ] Depth ------1------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No Water Table Depth. ------------------------------------------------Rock Size --------------------------- Distance to nearest: Well --------------------------•-------------Foundation -------------------- Prop. Line ------------....._ REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date -_-__--_.---_-_--_- ) ---------- - ___ Septic Tank (Specify Requirements) -------------------------------------- Disposal Field (Specify Requirements) _----_----_- Y 1 f----- --------------- ��f 4 r1 (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 beco# subijiatto Wa ompensati.on laws of Californi ' Signed Owner t By ------------------ ----------------- ---- Title ---------- -- (If other than owner) ----- - FOR .DEPAiRTMENT/USE ONLY APPLICATION ACCEPTED BY -- - DATE --__--- - -- -- ------____-- ---------- BUILDING PERMIT ISSUED ------------------------ ----------------------------------------------------------------- ---------------DATE ADDITIONAL COMMENTS ---------------------- ------------------- - ---- ----------- --- ---------------=---------------------------------------------------------------- Final Inspection by: --:-- ----- - Date __ _ ; ----- ---------- - -----.--`----- SAN JOAQUIN LOCAL HEALTH DISTRICT t E. H. 9 1-'GS Rev. 5M