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FOR OFFICE USE: APPLICATION POR SANITATION PERMIT Permit No. r � -------------------------------------------- --------- (Complete in Tri licatel Triplicate) Date -- --------------- issued ---------=----------------=------------ - - This P --------- ermit fzpires 1. Year From Date issued App liccition is hereby made to the San Joaquin rmit to construct and install the work erein Local-Health District for a pe described. This application is made'in compliance with County Ordinance No. 549 and existing Rules and Regulations. ---CENSUS TRACT --------------........... , 6 JOB ADDRESS/LOCATION _. Phone ----6---'-------- _7__ -- ---------- Name ----------------------------- - ------- --- ----- ----- ----l- ------ _ --------• City . -- - - -- -- -------------------------------•----•-----x Address ---=--- �- ----3 66—`��Url ------ ----------------- -- - O� / Phone `7<_ ----- ----- - - - ------ - -- -- - -- -- - --- --------License # 1------ .--------------- Contractor's Name ----- -- ---- ------ ----- - - - - - - - ---- Contractor's will serve: Residence ❑ Apartment..House,❑ Commercial ❑Trailer Court i❑ Motel ❑other L",� t-v' Lot Size --------- -----•------- �Garbage Gririder ---------- - �r Number of living un -1 Number of bedrooms __-_____ ----------- Private - ----------------- Water Supply: Public System and name --- --_ ---- --------- Clay ❑' peat F1 Sandy Loam ❑ Clay Loam ❑ fl Character of soil to a depth of 3 feet: Sand❑ Silt o 'Hardpan ❑ Adobe ElFill Material ------------ if Yes,type - jk.. laced on reverse side.) �1 i (Plot plan:, showing size of lot, location~of system in relation to wells, buildings, etc. must be p _. t,= .- it erm�tted if :public sewer� available"withinf200 feet,} � rr NEW INSTALLATION: (No septic tank or seepage p pr Liquid Depth - - - -` SEPTIC TANK Siz k PACKAGE TREATMENT [ } No. Compartments Z ---•- Capacity ��_ y � Material--�� +.s Capaci (--- ' � ---`----------Foundation _ --�.0------------ Prop. Line __s---•-----•----- Distance -to nearest: Well ------�0-- r LEACH1NG LINE No. of Lines _4i--- ------------ ---Length of each line-------f( _ Total Length ,-- --�-----•--------- - [ .. 'D' Box -"__---_---- Type Filter Material ��-----Depth Filter Material ----- 'D' --_f-- -----=- -------•-----•-----'---'- r /0-------------- Property Line �f Distance Eto nearest: Well ----- d Foundation - Rock Filled Yes 10 No 0 > Depth r----- Number -=-- I ;( Zr ,. E SEEPAGE PIT �Cl P z� - '� Diameter ----- F. Water Table Depth --------- Rock Size _- -�'--�� - Prop. Line ---- -----------=Foundation ---1 - Distance,to nearest: Well ------- t REPAIR/ADDITION(Prev. Sanitation Permit -------- -------- ------ ------ ---------=------------ Septic Tank (Specify Requirements) -------------------------- } ------------ ---------------------------------------------------------- ----------------------------------=-- = Disposal Field (Specify Requirements ---_-----___ F_--__-__.___-_ _____-_ ______________---------_____ ____________ _ ____________________________________________________________________ _-___-._ _ _ _ -- - ------ - --- - - (Draw existing and required addition on reverse side) , that the work I hereby certify that t have prepared this application and k will be done4n accordance with San Joaquin R County Ordinances, State Laws; and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the follthe work for which owing: s permit is person in such manner sed certify that in the performance of Compensation laws of California." ued, 1 shall not employ any as to become subject to Wo ------------ Owner Signed --------- --- - ------------------------- Title - ---------------------------------- -14 --Cu�-- -------- ---- -- ---- - (If other I n owner) EN USE ONLY I FOR DE � �Ii- Z•-Z`_._ --•--•- ----- - --- ------------------------ --- - -- ---------------- DATE - - .-- - APPLICA710N ACCEPTED BY --- DAT BUILDING PERMIT ISSUED --- ------------------------- --------------------- = = -. ---- ----- -----------------=-------- ------------------ ADM ------- --- ----------------- - - - ---- ------------- ------ ---- -------- ------------------------ --------- MENTS te - Date -�.------- - . Final Inspection by: - -------- SAN JOAQUIN LOCAL HEALTH DISTRICT u n 1_'f+R Rev_ 5M