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t FOR OFF.IL.. �e, . AWLICATION FdR SANITATION.PERMIT ....... - '� + r .. (Complete in Triplicate) _ Permit No: -. _7�- � -- ...I------------------------ --•-, _ - This Permit Expires 1 Year From Date Issued Date Issued ..... ./.? .J/ Application is hereby made to the ISan 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 .JQN ........ fT�/....-- - - - . -- - ----- --- --------------CENSUS TRACT .....................--.. Owner's Name .- AddressRiE Ci ^... Phone . ................�7 ! ?Contractor's Name . ...... icense #c; .SV../20 Phone !ZAI!l7921 Sl2 Installation will serve: Residence ❑ Apartment House Commerclaxrailer Court ] t Motel ❑ Other -----------.................. .. Number of living units;............ Number of bedrooms ............Garbage Grinder ......._.--- Lot Size ---------- }} Water Supply: Public System and name .-_............................-........_._--_.........-.. .._...Private F Character of soil to a depth of 3 feet: Sand's Silt Q Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam D Hardpan ❑ Adobex Fill Material ..r.-....__. If yes,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 if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK _.. --------- Liquid Depth ......_. [ 7 Size.......................... _ Capacity ----.------. Type -------------------- Material...................... No. Compartments Distance to nearest: Well ....................................Foundation ..._.__... Prop. Line LEACHING LINE [ ] No. of Lines _.____....__ .. Length of each line.....,.............._ ..... Total Length ........... 'D' Box ............ Type Filter Material'....................Depth Filter Material .........__................................. Distance to nearest: Well . ........... Foundation ........................ Pro party Line .......••----...._..- SEEPAGE PIT [ ] Depth _.................. Diameter --_._........... Number Rock Filled Yes 0 No JO Water Table Depth ---- ..... ............••-•-•.-----'--------Rock Size ..........-------------•----- Distance to nearest: Well ----------------------------------------Foundation .,.Prop,Line .----------........... I REPAIR/ADDITION(Prev. Sanitation Permit# ............. ... Date --- ------------------------------ Septic Tank (Specify Requirements') __.............._........__.-._-----..._ Dis osa,1, Fi�eld��(Sypecify Re uirem0nts) ............ _ ---.....--- (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 codifies the following: "I certify that in the perfo nce f t e work for ch this permit is issued, 1 shall not employ any person In such manner as to be a su •ett to o ma 's •ompensatl i s of California." Signed . -- - ?-- ---- . .......- Owner By'--'---- ... ...... ...... ... .... .. . .... Title ................. .. --- (Ifo an own FOR ,DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .... _..... ..........._--------_--_- DATE < BUILDING PERMIT ISSUED ...- �- - ------------------------------.. - - -- -- ---- ------ ...DATE ................................ .. - ADDITIONAL COMMENTS -------------------- -----•-------------•---....-•---- ...................... .......;---------------- ............. ... -------------------------- - -- ...................... ...---- / 1,rt Final Inspection by- ------ ------- - -------- ------................... -- -----------------.Data .._Ct.'i��_Y�.t......-...-'------ - - ............................ SAN JOAQUIN LOCAL HEALTH DISTRICT