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FOR OFFICE USE: � APPLICATIC�TV FOR SANITATION PERMIT -�j�'��--�- �---•- -- Permit No. ------ - !d (Complete in Triplicate) ----------------- # .� Date Issued ---'l - * . This Permit Expires I Year From Date Issued -------------- Application is hereby made to the San Joaquin Locdl 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: CENSUS TRACT JA ----------------- JOB ADDRESS/LOC TION ---------- -- ----- ---------------`.�- ----=----- - -------=----------: Owner's Name + - -- -------- --- ---Phone ------------- Y l Address . --- City �-� . � C ' r ' -------.License Phone ��` - 1 Contractor's Name -------------- -------- --- . --------------- Apartment �, . ' installation will serve: , Y ' Residence ❑ Apartment House Commercial ❑Trailer Court l,❑ Motel�Other -- -- ---- -- _--•------ � - - ------- - t � 4 Number of living units./PW---Number of bedrooms ____________Garbage Grinder ------------ Lot Size ____-----------------_______________ Water Supply: Public System and name ------- ---- -- i - `.-- ------Private ------------------- Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam;O Hardpan ❑ Adobeg Fill Material ----- -_- If`yes,type ____________________________ relation to wells,.buildings, etc. must be placed on reverse side.] {Plot plan, showing size of lot, location of system m e NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 20lfeet,] `A PACKAGE TREATMENT [ ] , SEPTIC TANK I ] Size----------------------------------- ------- Liquid-Depth -------------------- capacity Type Materia[ --'-------------- No. Compartments - •-----_ p tY ----------------- Distance to nearest: Well ------------------------------•-----Foundation _-'------------------- Prop. Line --------- ------------ . ti LEACHING LINE [-] No. of Lines ---------------------- Length ofteach line----------:............------- Total Length ----------------------------- 'D' Box ------------ Type Filter Material --------------------bep#h. Filter Material ----------------------- Distance to nearest: Well ---------------------- - Foundation ----t=----------------- Property Line --------------•--------- Depth ___ Diameter _______________ Number r-j__-J--..___-:----------- Rock Filled Yes ❑ No SEEPAGE PIT L 1 I� ---------, - Water Table Depth -------------------- ____. _____:Rock Size --------------------------------- ' Foundation -------------------• Prop. Line ---------------------- Distance to nearest: Well --___--_________________--------------- REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------- ---- Date -----------------------•--------• ] ` - .r Septic Tank (Specify Requirements) ----- ------ - -----------•------ --------- Disposal Field (Spe 'fy Requirements) �`� ------- ------ ------ -- i - - ---- ------ --------------- ------------- - - - - --------- -- -- ( raw existing and required a clition on reverse sie] I hereby certify that I have prepared this application and that the work will be'done in accordance with Son 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 shail not employ any person in such manner as to be e s b]ect to orkmagi 's Compensation-laws of California." /..- -- Owner Signed �'� `'--------- Title ------------------------------ ----------------------------------------- (If other th n owner) 1 MENT USE ONLY APPLICATION ACCEPTED BY ------------ ----- -------------------------------------------- DATE ---- =�� ` ��------------ DATE -------------•----------------------------- BUILDING PERMIT ISSUED -----_--- -=--i---- -- ----- --�_-- _ -- '-------- ADDITIONAL CO ENTS I -------=---------------p------------ ------ �" -------- - - -- � - �-------- ria- -- 9 � ' ' - fir' --` _ --------------------------------- y' Final Ins tion -----------------------------------.Date �� -47/l`.- '� - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6B Rev. 5M.