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,PPLICATION FOR SANITATION P IT F............ . ..................l !......_ Permit No. .b.. �........ (Complete In Triplicate) ............................... Date Issued ... 6 .:. ......... .................................. This Permit Expires ( Year From 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 Coun y Ordinon No. 54 . and existing Rules and. Regulationse JOB ADDRESS ......N ......�..._.... .CENSUS TRACT .......................... Owner's Name .. .. ........... Phone 1014Q.....�..� r Address .............. .. _ �... c ....City ... License !• . Controctor',s Name ................ •....... .�-�. Phone .�f.. . Installation will serve, Residence Apartment House❑ Commercial❑Trailer Court ❑ ' Motel ❑Other Number of living units•_-- Number of.bedrooms Garbage Grinder ............ Lot Size g ............... ........... I Fj Water Supply, Public System and name ,--•---•.............................--•-•-•--...---...._........_.........................................private, Charbcter of soil to a depth of 3 feet, Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam fl Clay LoarrtX G Hardpan❑ Adobe❑ Fill Material ............If yet.type ............... ............ I !Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed an reverse tide. NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) l PACKAGE TREATMENT ( ] SEPTICTAN� Si ��....... .............. Liquid Depth S;. Capacity/d�O.0---.. Ty ,!� . .... Material-- / _... No. CompartmentsF ... •.•--•. . ' istance To nearest. Well .... ...Foundation ._Zo.� . Prop. Line ... - - g -- r BEACHING LINE [ No. of Lines �................ Length of e IIneI- .... .... Total Length .. .....•••--• it 'D' Box ...4.... Type Filter Materlal�l. 4.Depth Filter Material . ./ •�• . . . .. ..... . Distance to nearest, Well ......-....ay. Foundation .........•.••-• Property Line 6.. . ..... s [ 0Z........... SEEPAGE PIT [ Depth .. ........ Diameter . ....... Number ._........tZ:. ...... Rock Filled Yes No Water Table Depth ...... ........................Rock Sizec,.r2 Cs .�.__........._ Distance to nearest.. Well ._y� Q.._.._7 .............Foundation ...g ........ Prop. Line .. ............. REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Daae ..................................I SepticTank (Specify Requirements) ........................................... ......................... ...........................,......................_............... Dispasc+l Fiala (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 wins Sar Joaquin k County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or titan. 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 bet a b ct to rkma 's Compensation laws of California." �-^: .anec� ... �"P'�'. - ...._...... Owner By ..... .................. � r :4� .. . ......--•----.- ... xitfe .... .,r......................... If other than owner �r� "I'' ( 1 FOR DEPARTMENT USE ONLY � = DATE ._..... ..�i.. . --� APPLICATION ACCEPTED BY ............ . ..:. ........._.................................. ..............�. BQILDING PERMIT ISSUED ...... .. ............ DATE: .:. ...... .................... •--•-- .... ADDITIONAL COMMENTS ....- '..O/9f---- .... ..... .,�o............................ .. ......, :r .. ._. -. . ._...... ............................... Final Inspection b Dale -- - �87 ..._._EH 13 21t 1-5Fi flev, 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 3M