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UX u'flu u5tiI APPLICATION FOR SANITATION PERMIT ,: ............................................... ( omplete in Tripllcate) Permit No. .. '�.. ..................................................... . CD Issued Date issued kt-2d ............. ............................ .. This Permit Expires Z Year From Date s Application Is hereby made to the San Joaquin Local Health District for a permit to constrict and install the work herein described. This application is made in compliance with County Ordin nee No. 549 and existing Rules and Regulatlons: JOB ADDRESS/LOCATIOGz�.p�G. . . CENSUS TRAC' .......................... Owner's Name ....................................... ...... ............................Phone .................................... Address .................. ......._._..city .to ............................................:................�_. A Contractor's Name _.. _.�.. License��,,,/7..�Z... Phone d ws?il.. �, Installation will serve silence( partment HouseQ Commercial OTraller Court 0 Motel 0 Other............................................ Number of living units:............ Number of bedrooms .)f_:---._Garbage Grinder ............ Lot Size .................. ........•-��i Water Supply, Public System and name ......................._......._................................Private - ............_. Character of soil to a depth of 3 feet: Sand 0 Slit 0 Clay 0 Peat 0 Sandy Loam Q Clay Loam Hardpan❑ Adobe Q Fill Mcterlal............ If yet,type............... ............ (Plot plan, showing size of tot, location of system In relation to wells, buildings, etc, must be placed on reverse slds.l< NEW INSTALLATION: (No septic tonic or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ) SEPTIC TANK[ j SSizey.. ............................................. Liquid Depth ....................... Capacity . ,D�O Type Material........ No. Compartments ............ Distance to nearest: Well ...l�Cr}.�. ..Foundation ... Prop. Line �" ... Length of each line........-l.____....... Tota! Length ...Z-=1.....J..... LEACHING LINE ( ] No. of Lines ng 'D' Box I......... Type Filter Material . _....Depth Filter Material .. ......................................... ...... . . . r Distance to nearest: Well ........................ foundation ..............:......... Property Llns ...................-.. SEEPAGE PIT [ ] Depth ................ Diameter ................ Number ............................ Rock Filled Yes 0 No i WaterTable Depth --•-•--------•-•................................Rock Size ................................ Distance to neorestt We!! ._...- p- ......_.._......... ...............Foundation ---•--.._....----••- Pro line ........._.--.---.... REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ..................._............. ) SepticTank (Specify Requirements! ......................................... ............................................................._..._.........._...._._........_ 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 District. Hesse owner of 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 beta. - _/_ RAO subject to orkm 's Compensation laws of California." Signed .. . - ... . ............................................................ Owner By .................. ...•-••----..-._ 7itle -----.........................---•........----.......................... (!f other than owner) - It DP R TUSE ONLY APPLICATION ACCEPTED BY . . . ......................................... DATE BUILDING PERMIT ISSUED ................... .. .......................................................... •---........:........................... .................................................. ...................... ----------...................... ....................----...............-- ........... ...................................... ....------------........ .. . . final Inspection b ..Date .. '`.. �. ............. EH 13 2!i 1-6£i Roo: SAN JOAQUIN LOCAL HEALTH DISTRICT 8�7}� �H