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,-� FOR OFFICE USE: • APPLICATION FOR -SANITATION PERMIT ....................................I.......I........... {Complete In Triplicate) Permit No. # This Permit Expires 1 Year From Date Issued Date Issued /.- �: 7 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 OrdirWce No. 449 and existing Rules and Regulations: JOB ADDRESS/LOCATION 1_�t1' ? Y`,. _..: - .�? ?_. �I .. . y�J ! ! ! -... .... .`.�`<..... .CENSl1S TRACT .......................... Owner's Name ... ,`'.-:::.'.. .........................--- Phone.......... .......................... Address . 1 ..- .... ...._. ._.. _ City .. Contractor's Name �.......... ..... 4de _.... _ ��:�:.... . .... ::._.......License # .��.� ..�...._ Phone .............................. installation will serve: Rese❑Apartment Hou pj2 Commercial ❑Trallw Court ( ?Ae �7 ( Motel ❑Other Number of living units:............ Number of bedrooms ............Garbage•Grinder ............ Lot Size ........................................ Water Supply: Public System and name Private ` Character of soil to a depth of 3 feet ,••Sand❑ Silt - Goy ❑-• Peat❑ Sandy Loam.e Clay Loam ❑ Hardpan Q 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,) _I PACKAGE TREATMENT f ] SEPTIC TANK I ] Size................................................... Liquid Depth .......................... Capacity ' Type ... Material...................... No. Compartments ...................... WOW Distance to nearest: Well r................ _.....Foundation ..... Prop. Line ............:. LEACHING LINE [ No. of Lines ..................... Length of each line-------•......... ......... Total Length ............................ D' Box Type Filter Material ..Depth .Filter Material .................. ...... . ... . . -------------------- Diameter ---•--••-_:..... Number ation ........ :..._. � Distance to nearest: Well -------------------- Found ...... :.... Property Line .......................... m.. SEEPAGE PIT ( I Depth -- ..................... Rock Filled Yes ❑ No � sr Water Table Depth .....Rock Size S ; Distance to nearest: Well .............. ...foundation -------------------- Prop. Line ...................... 1 REPAIR/ADDITION.(Prev. Sanitation Permit# .....................--------------------------------- Date Septic Tank (Specify Requirements) ...:.... .. . ... . ............I........ a pos I Field (Specify Requirements) r�,.. , t ........ ........ .... . . ............................................................ � -----.....---•--......... � . -------------------------- --- --------- ..................................... ...........................:......................._-............... {Draw existing and required addition on reverse side[. I hereby certify that 1 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 Son Joaquin Local Heallh.District. Hoene owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is Issued, 1 shall not employ any person in such manner as'lo become subject to Workman's Compensation laws of California." Signed ----------------------------------------------- -------. .... .............._.- Owner BY Title . ...... Of other than owner) _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED $Y ----._. DATE,._...�:`. .��----------� BUILDING PERMIT"ISSUED4_..'":..---- .......DATE ........:._.::...:._.... .................. ADDITIONALCOMMENTS - -- --•- --- '..................•-....._..._._._._.--------•----..... --------------------------------- ----------..--._...-................ ............. k ------------------------------ _ . -..- � .._........---- -- ..... J FinalInspection by: _-- -_ .-••--•------------ -------- -- ----------------------------D ._... . ........ . ' EH 13 2h 1.68 Rev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M t