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FOR OFFICE USE: -- ------ -- ' APPC CATION FOR:.SANITATION PERMIT -- (Complete.-in Triplicate) Permit No, This Permit Expires 1 kYear From Date Issued ----Issued ____{ Application is hereby made to the San Joaquin District for a permit to construct and n j described- This application is made in compliance with Count- -r- inance No. 549 and exis in Rules and Regulations: y stall the.,-Work herein ; , t g JOB ADDRESS/LOCATION ...(?t �_- �� ``•x.G ~"�� - a �_- ''� — --CENSUS TRACT ° l— X74�OI Owner s Na "".� - a JPhone,AddrCity Name - - ---- ess ..-_ - - nep -r ---- License one ____Installation will'serve: esidecTt House E] Commercial[jTraifer Couet _v Motet ❑ Other Number of livin units`` __. *y 9 - Number of bedrooms _-- Garb e Grinder Water.Su 1Public System andname -'--- __° # 9 Lot Size ------ ------------------------------------- y.PP Character of,soi!to a depth of 3 feet; Sand'[ Silt-:(]+""'"Cia -------------------- --- `--i---- ----------- -- -- - - - ----------.----- --- • - - - - Pnvate;(�' Q Peat ,��Sand Loam i Sandy ❑ Clay Loam:❑_ Hardpan ` - r p ❑ `Adobe FiII Material __- ,- --_ If�yes, type --- __------------ NA Plot plan,- ihowing: size of lot, location J system in relation to wells, buildings,' etc. must be laced on W INSTALLATION. ¢„� f P re erse side.) {No septic tank o#seepage pit permitted if.public sewerisavailable within 200 feet,) if i PA Y E TREATMENT [ ] SEPTIC TANK � . f,.]. . ; ......=Size ------------1 Liquid Depth ----- it -------- ' Capacity __-_ Type ----- Material-` ¢' ---------------- No. Compartments - -- Distance to neatest. Well ---- ------Fo_un{dation' ------ Prop LINE f h Line - r - -------- No. of LineIs ----- Lenacline--- __--- Total Leng th D' Box __-__.------ Type Filter MVrria -------------------DepthiFilter Material -__ -- _- -_ -- Distance to nearest: .Well --------------- ------,Foundation ---.------ SEEPAGE PIT ------------------------ Property Line �__ .. —�_ [ ] Depth -------------------- Diameter Number ------------------- Rock Filled Yes No �] Water Table Depth ------------------------------------------Rock Size I ' I Distance to nearest: Well ---_---------------------___ __.-__Foundation ----- ----- Prop. Line -------------- ------- --------------- PAIR/ADDITION{Prey. Sanitation Permit# --------------------- - i ` ------ ------ - Date ----=--- -------- ---- - -- - Septic Tank (Specify Requirements) ----------------- -------------------------- - -------------------------------- Disposal Field (Specify Requirements) ------------------------------------- - ----------------------------------- -- ----------------- - - `- - `------------------------' .-�.� r - --- - ---------------------------- (Draw existing and required addit on revverse side) a I hereby certify that I have prepared this application and that the war 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 certifies the following: "I certify that in the performance of the work for which this permit is issued I shall not employan as to become blect to'Workman's Compensation laws of California.” y person in such. manner Signed Owner . ----------- Title I other than owner) ' FOR DEPARTMENT USE ONLY „ APPLICATION ACCEPTED BY .- - BUILDING PERMIT ISSUED - DATE ---------------- ---------- DITIONAL COMMENTS . -------- --• DATE ------------------ - -"------------------------------- .------------ -------------------------------- ------ - ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ Final Inspection by: - - ----- -- --------------Date ' 0 SAN JOAQUIN LOCAL HEALTH DISTRICT .E•-H• 9 1-'6$ Rev. 5M