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FOR OFFICE USE: /if FOR OFFICE USE: ao APPLICATION FOR SANITATION PERMIT -- -- ----------- - (Complete in Triplicate) Permit No., :_- - Date Issued-��3.=?... .........•..........................................----- This Permit Expires 1 Year From Date Issued 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. 549nd e.'sting Rules and Regulations: JOB ADDRESSAOC T/ON_,A�-- -.- .... -- -- ------ --- -- --- `-,- -- -- -------------------------•--.CENSUS TRACT...........--...... 47 Owner's Name.. ------ . . a # %.-C. . ^ ...P-h.-one ------- -------v---•-.-.-...----.". c..J.- . ----- ....---- Zip---=-------- ........... Contractor's Name...... . W - License -q.1Phone.y Installation will serve: esidence - Apartment House ❑ Commercial ❑ Trailer Court ❑ 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 (Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ 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.) NEW INSTALLATION. (No septic tank or seepage pit permitted.if public sewer is available within 200 feet,) t�1 PACKAGE TREATMENT g _ 1 ( ] SEPTIC TANK ( ] Size - .. ------ Liquid Depth. v f Capacity....-- --------.Type----------- - - -- Material--i-----------------------No. Compartments-------- ------ Distance to nearest: Well................................. .........Foundation------- -- - ---. -.--....Prop. Line............---.... .r....- LEACHING LINE ( ] No. of Lines ........ ...... Length of each line -------------------_-------Total Length - ------------------..-.-.----..---.-- 'D' Box-.. ......Type Filter Material-------- -----------Depth Filter Material-------------------.----.-------------------------.--=........ - Distanca to nearest: Well--------------------- ----- Foundation----------------------------Property Line......----------------.----------- SEEPAGE PIT [ ] Depth.......... .....Diameter--------------......Number-------------------------------- Rock Filled Yes ❑ No , WaterTable Depth----------------------------------------- ---------------Rock Size.--............. . ---------------------- Distance to nearest: Well...........................................Foundation...-.------- .Prop. Line------ .-- ......-..... RIrPAI ADDITIO rev. Sanitation Permit#----------------- --------.----,,Date---.._.............-.__-...--------.-----•-...] Se tic Tank (Specify Requirements].-...-.-----_-- - p { P Y ------- - --- - n / ....... ----= ----- 32 - Disposal Field (Specify Requirements)........--�-,-: ---- . ...... - ../)_ .-.--. .......... e... ---... -----•-•--•---•--•----- ---------------------------------- -- ----------------------------- - ----------------••-------- .....----- -------------------- ------------ ------------------ -- ....... ---------------------------- --..................•--------------------- .... --- -----------•__....---------------- -------- (Draw existing and required addition on reverse side) I hereby certify that I 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 San Joaquin Local Health District, Home owner or licensed agents signature certifies the following: "I certify that in the perfoVoththan the work for which this permit is issued, I shall not employ any person in such manner as to ecome s b]ect to Woompensation aws o Signed..... ----- --Owner By------------ - `Z ------- ------------------ ---- --......-_Title ---------------- ........... (if owner) PORIDEPARTMEDIT.JUSE WLY APPLICATION ACCEPTED BY �f ----------------- -DATE _ .ps....---- -- DIVISION OF LAND NUMBER.-. • ................._... ...--- -...-- DATE....-- --------- --,...........- -- -- ---- ADDITIONAL COMMENTS---------000-t-----------nT1.4.L�-... _ c�`.. .. ... 3 _7Y 2 ---------------------------r ---------------------- ------- -- -- -------------------- ----------------- --------------------•------------------------------ --- ------------ .......... ............. -------•-------------------------- ------------ - --- .. ........... ...•----------------....-------- ---- -------- .. ---- --------- ------- ----------......--- ---- z ........ V Final Inspection by:.. ----------------•----•---------------------- EH 13 2a SAN JOA UIN LOCAL HEALTH DISTRICT F&5 21677 REV. 7176 3M