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APPLICATION FOR SANITATION PERM .t 7� ° (Complete In Triplicate) ........... Permit No. ..................... . ..............•--••...._......... 1 _ ...................•---........-_-----•• ..... This PermitExptres 1 Yew From Date Issued Date 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: JOB ADDRESS/L CATION ..��1. So._�--,.. �........ ....................................��►r. i . . CENSUS TRACT .......................... Owner's Name t.................................................................................................Phone ..a�. .Y�) 0..........:.. Address �I...... ................-City �v ..............................................._...... .....License .... Phone .:.............. Contractors Nome ......... Installation will serve: Residence Q 'Apartment-Huta �] 11d1-0Trdil Cert-0— Motel p Other 11Lav ................ „ Number of livingunits:.. -_.-.._ Number of bedrooms -a-______ ��- Q.G�,h.. Garbage Grinder -..--•---•-- Lot Size ..... ...........•- -�... ....._......_.. Water Supply: Public System and name .........I._. .......Private r ..._....................- - .....�._....................._ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat Q Sandy Loam ❑ Clay Loam Q iHardpan [] Adobe Fill Material ............ If yet,type ....I.......... ............i (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (Ido septic tank or seepage pit permitted if public sewer is available within 200 feet,! It' PACKAGE TREATMENT ( ] SEPTIC TANK[ -------------------------- ------ - f :L.............. } Size ._---_--._--. . Liquid Depth .._... .. i Capacity AQ4-00r ... Type��. .. __. Material._'.`_ _�4_. .►�i.�.. No. Compartments ti'. '..............J i i �MM � Distance to nearest: Well .-_- 00......................Foundation ....�-d......_...___ Prop. Line .� .I`!!! Q.�..... 1 r�.� Total Length �d'Q. 0 LEACHING LINE ( ] No. of Lines ----------------•-_--_-- Length of each line..----•.-.-- ....... .._. ._ ..!._...... ....._...... I q,, 7 D' Box �!{?..... Type Filter Material .._...___.Depth Filter Material ........1..I.......�t_..7---________________ rn Distance to nearest: Well ..... ................ Foundation ..... ............ Property Line . ........... SEEPAGE 1" ko/ SEEP` AGE PITS ( J Depth .ate............. Diameter �__._.-_... Number .......I.......__.... Rock Filled • Ye� No ❑ Water Table Depth _. ..........................................Rock Size ...9'-1.................... L Distance to nearest: Well ........................................Foundation .................... Prop. Lina.....................� r � REPAIR/ADDITION(Prev. Sanitation Permit 5� --•f........................................ Date __:_....____---_-_-•___..�.��0 Septic Tank (Specify Requirements). ..... ................•--------•---......................................_........-................. Disposal Field (Specify Requirements) ) -------•------------- ------- ---"------------------- ------------ ---------------- .. --------...._......------..............._•----.-------- . ------------------ ------ --- ---- .......---------•------ ....- -- ..._.. ..... ---•----.. ..� ........... ......:..._................................ I, I (prow existing and required addition o reverse side!•- I herebycern that A.have re' 'a �work-will�^ A � certify, -prep re�l�this,appllcation and that the be done in accerdonce with San looquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health,District, Home owner or licen• sed agents signature certiifes the following: -' ,�� "1 certify that i e performance of the work for which this permit is issued, 1 shall net employ any person in such manner astofbeco su ect t Compensation laws of California." Signed _. •--------------- Owner I By ..............' ......... .......... .................................................. Title ......... .-. , Of other than owner) FOR DEPARTMENT USE ONL.Y - -- APPLICATION ACCEPTED BY ........................................ _. ./ ........... DATE DATE ....-......• �' .............. ------ . ...... �... .. BUILDING PERMIT ISSUED ............... ...................•------•----• --...........---- ---- ............---- --......----.. ADDITIONALCOMMENTS ...-- ..........................._......--•---•--.....-----------................... ............................................................................-._..............-------- ------- ..._.........._.... ... .......... ............... --- ..... .---- -- ................................................. .................................................... 1. D Final Inspection by: .... ! " '.. .......................... ate . ......�.. " _• a .. .--.. .-- EN 13 2h 1-68 fev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M