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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT f� --------- - --------------------- (Complete in Triplicate) Permit No.------------ . ----'----==--.--� This Permit Expires 1 Year From Date Issued 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 49 an 'existing Rules and Regulations: JOB ADDRESS/LOCATI ___� � -- / dJmnr( / `'` CENSUS TRACT ---------------------_--- Owner'S Name _ -- -----P one._c3------ ��y`'�('�`1/ /�lJJo Q®�--- --- ------ -City -- k`1"u ° Address --- f!.Fsl s..�`r -------------•--- Contractor's Name -------------- ----------- ---.License # ---------:-------------- Phone ---------------•-----••- -- - -- ------------------------------------------------- Installation will serve: Residence partment House^❑ Commercial :❑Trailer Court ',❑ 'Motel ❑Other ------------------------------------------- Number of Living units------------- Number of bedrooms --e-�_ -Garba_ge Grinder ------------ Lot Size ------------------------------------------ Water Supply: Public System and name --------------------------------------------------------------------------•------------- - Private ! s Character of soil_�to a depth of 3 feet:..._Sand'❑-_ Silt❑. Clay E].- Peat❑ Sandy Loam. lay Loam.,:[]_. Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type ---------------------------- . Y (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,) PACKAGE TREATMENT [ ] SEPTIC TANK:( I Size--------------------------------------- ---- Liquid Depth --------------------------� - — ..-. --_- . ...v. .. - r.--my . _�..i „�� - .. Capacity ---------- ---- Type -------------------- Material--------------------- No. Compartments YP Distance to nearest. Well -------------------------------------Foundation ---------------------- Prop. Line ---------- -----r LEACHING LEVE [ ] No. of Lines ------------------------ Length of each line------t Total Length---------------- - 9 --------------•-- :___---____ 'D' Box ___--- ---- Type Filter Material --------------------Depth Filter Material ---_____------------------------------------ Distance to nearest: Well ------------------------ Foundation-------------------------- Property Line ------------------------Z SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number _----- --------------------- Rock Filled Yes ❑ No CD WaterTable Depth -=------ ------------------------------I--------Rock Size --------------------------•----- Distance to nearest: Well. -------------------------- -----------Foundation -------------------- Prop. Line -----•-----••--------- a ~ ------ Date ---------------------------• ) '1 REPAIR/ADDITION(Prev. Sanitation Permit# ------- .-�------------------------ Septic Tank [Specify Requirements] ---------- $h Gam' - ..... ` Di s os 1 Field Specify Requirements) -- --- _�-9�� _ ---- -- ------- T- -:-;�.,� .------- , - -----„---- ---- ------- here--- (Draw existing and required addition on reverse side) by certify that i have prepared this application"and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules`cind-Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance'af the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's the laws of California." Signe -=------ ------------ ,--------------------•-----••-------------- Owner ----------------------------- c€ Title ---- ----- ------------------------------------- -- ---- ---------------- - ------ -- (!f other than caner) ' -FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- ----- ----------------------------------------------------- DATE . BUILDING PERMIT ISSUED -------------------------- ------- ------- DATE --------------------- --------------------- ADDITIONAL ----------•-------•---------•-•----••--- ADDITIONALCOMMENTS ------------ I --------------------------------------- ------------------------------- ----------------------- -------- ---------------------------------------- ------------------------•- ----------------- ----------------------------------------------------------- -. _ Date r �-- Final Inspection b ------- ------------- •- -- t P Y ----------------------------- M a SAN JOAQUl1v LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M I