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f •--T^.........C APPLICATION FOR SANITATION �PE�IT �61 4W 1Cample1e in Triplicate}. . ..... Permit No: . ....... . ....D. ......Y.... NN '. This Permit Explras 1 Year Fram gate Is Date Issued ....®� .. Application is hereby made to the Son Joaquin Local Health District for a permit to construct and Install the work Therein described. This application is made in compliance with County Ordinance No. 549 and existing.Mules and Regulations: JOB ADDRESS/LOCATION, I j ...........:...............CENSUS TRACT .. ... �a -. .- . .._.. Owner's Name ---... _ ....................... Address ...............'1,-�. Phone ., ....._......... ........_ :..v..._. ......city ..._ ....... ..... Contractor's Name -- . License # l i-4 3e? . ... ...... Phone ................... Installation will serve: Residence Apartment House❑ Commercial[]Trailer Court 0 Motel ❑Other ..... .................. Number of living units:.....[ Number of bedrooms ... ........Garbage Grinder ............ Lot Size Water Supply: Public Systern ancl'name ....................... .........................................� Charade _. ..-..... . .Private Character of soil to a depth of 3 feet: Sand n Slit❑ Clay Q Peat 0 - Sandy Loam 0`. .Clay-Loam Hardpan[� Adoba FIII'Material ........_... 1# Yes,type ........................... (plot-plan, showing size of lot,. location of system in relatiori to wells, buildings, etc, must be placed on reverse sided NEW INSTALLATION:. (No septic tank or seepage pit permitted if public.sewer Is available within 200 feet;) PACKAGE TREATMENT J ] SEPTIC TANK{ ' Size ... 1.�:....,.f' .............. Liquid Dep#h :. ..---- Capacity ... o. �'. Type Material.. . No Compartments ................ Distance to nearest: Well .........�Qar:.. ..t --•----Foundation.._..� .: .....Prop. Line... : LEACHING LINE ( No. of Lines ......... .......:. ,,J .. Length of .each line. � -� . Total Length __ I.P.s.�,�( `D' Box ...... Type Filter Material ..... .......Depth Filter Material �y.':....,.. Distance to nearest: Well .....].t2�a. - Foundation ..........&g—.. Property Line ........5�.. . SEEPAGE PIT 141 Depth j ' - Diameter ..,........ Number .-----..._ .....: ..... Rock filled Yes No ❑ Water Table'-Depth ..... -:fes.-1.es7A.. ..... .Rock Size Distance to nearests Well ....,,/ ': _.•....Foundation : Prop. Line REPAIR/ADDITION:(Prev. Sanitation Permit# ...................... --.... Date ................................. ) Septic Tank #Specify Requirements) . ..... ................... •....... - ................. ....................... ................. Disposal Field .(Specify.Requirements) ...............I.............. .- ........_. ......................;...._......---......................_...- _ .........................:....................................... •-------•----•----•....-••....-----•••• ••.................. ..�.... ...... ......... � ........................... ............ . Draw existing and required addition on reverse sidel -- 1 hereby certify that I have prepared this application and that the work will be done in accordance,with San Joaquin Copnty Ordinances. State claws, and Rules and Regulations of the San Joaquin local Health District. Home owner or licen- sed agents signature certifies the following: "[.certify that in the performance of the work for whlch:this permit is issued, i shall not employ any person in such manner as to become subject toWork 's Compensation laws of California.,, Signed:....... ................... ' . ......... ........ . .. _ Ovine BY .. w (if other t an owner) FOR DEPARTMENT USE ONLY APPLICATION.ACCEPTED BY... `... . ..:_... DATE L :...: ..............::..:... BUILDING PERMIT ISSUED .......... ............. .... . DATE ADDITIONAL COMMENTS ......:....... ......... Final Inspection by: . ,_._ ate}/ ................................... ................_......... " �..................._...... 0 a .Date SAN JOAQUIN LOCAL HEALTH DISTRICT