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FOR OFFICE USE: `''APPLICATION FOR SANITATION PEt.AIT _ ............... (Complete. -.-...._ Permit No. _ -----/C---- ------- ------ - (Complete in Triplicate) Dare Issued .-. -_- -__ This Permit Expires I 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 County Ordinance No. 549 and existing Rules and Regulations: tuc c- ..CENSUS TRACT .-. JOB ADDRESS/LOCATI I�.`Z-�l_.C:�_L(-2/<t�2n�za +� _ -------------- Owner's - - _ Owner's Name .... a --- -- --------- ... - Phone _._--- ---------------------- Address - - - �r _�..-f .� l GQ'=e. City `11 c�zfu. - ----- -- - - - --- --- -------------- Contractor's Name -f�''' � '---- -- --- -----License # -bQ. - J._ Phone b7.�i�=-- -y✓-•. �- Installation will serve:/ ResiMence ®Apartment House❑ Commercial ❑Trailer Court ❑ VVVv Motel ❑Other - - --- ------ -------_..---- ------- Number of living units:...! ----- Number of bedrooms -.4 --- Garbage Grinder .-Q--- Lot Size Water Supply: Public System and name ._...--_..--_-...----- ----- - --------------- ------ ....Private 54 Character of soil to a depth of 3 feet: Sand j] Silt❑ Clay (>-Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material _-_ ------ If yes, type .-------------.....---- -- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.l NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,l PACKAGE TREATMENT [ j SEPTIC TANK[ j Size---------------- ---------------- ----- - Liquid Depth ------_..---.-----..--_- Ca act Type -- --------- Material-------.._._.-.... No. Compartments -------------------- )d Distance to nearest: Well .-_------------------------------Foundation ._....--------------- Prop. Line ---------------------- - LEACHING LINE [ j No. of Lines __--------------- -- Length of each line._-------------- -- _ Total Length ----------- -------------� 'D' Box ----_.._-- Type Filter Material ....._------.-----Depth Filter Material ._._.---------- ----------------------- ProLine . ----- ------...... Distance to nearest: Well .. ---_._._.--------- Foundation .---..--------- ----- Property _ -- SEEPAGE PIT [ j Depth Diameter .. --- --------- Number ... ... -- .. Rock filled Yes ❑ No 0 Water Table Depth _ - - - -- --------- -------- --------Rock Size ------------------ - Distance to nearest: Well ._ --------------- - ----------------Foundation -------------------- Prop. Line ..._-------------- REPAIR/ADDITION(Prev. Sanitation Permit# ----- ---_ ----- ---- -- ..----------- Date --------- ------------------------) fb -- --------- - ------- Septic Tank (Specify Requirements) - ---� - � ---- - �r+ �y/ --�--� /.,` ..--_---____ Disposal Field (Specify Requirements) ---- - Jam''""--� ./� t/---- L'.._.`Fi- --------- - -- -- -- - ---- ---- --- ---- ----- ----- - -- ---- - ----- - - - - - (Draw existing and required addition on reverse side) e will be done in accordance with San Joaquin hereby certify that I have prepared this application and that the work 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: 111 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 become subject to Workman's Compensation laws of California." Signed -_---------- Owner .. _ - -- -- - ti _ _ _ T BY itle �L y - ` (If other Thaowner( FOR DEPARTMENT USE ONLY DATE ----- - APPLICATION ACCEPTED BY . -ZrvJ !tf - ------------------ - - -- --- DATE -- BUILDING PERMIT ISSUED - -- --- - - -- - - - .. ---- -- - ADDITIONAL COMMENTS ---- -- .. ------ -- --- -- ----- ---- ---------- - - ......... - - - - - - _ - Date - Final Inspection by: �- SAN JOAQUIN LOCAL HEALTH DISTRICT