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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No- --------------------- --------------------------- ------•----------- --------- (Complete in Triplicate) ///7 e�l - -------------------------------------- _- p Date Issued -- ------- This Permit Expires 1 Year From Date Issued - the al all the work herein Application is hereby madeto adeain compliance en Joaquin cwi he County tOrdinance permit and existing Rules tand Regulations: described. This application r' ____ __ CENSUS TRACT r JOB ADDRESS/LOCATIO ._.Phone ------ -------- --------==---------. � Owner's NameOf City-------•-------------- Addresse-,T6 License ------ -;- --- ------- Phone ------- -------- --------•-- Contractor's Name --------��l- ----- --- ------------------------ ------- # --� Installation will serve: ,Reidence partment House❑ Commercial ❑Trailer Court l❑ Motel ❑Other -------------------------------------------- Number of living units:-_._- _____ Number of bedrooms ------------Garbage Grinder __ Lot ize ------------- _____________ ----------------Private Water Supply: Public System and name ------------------ -------- Peat Sand Loam ❑ Clay Loam.0 ± Character of soil to a depth of 3 feet: Sand' Silt❑ Clay ❑ ❑ Y Hardpan ❑ Adobe '❑ Fill Material ------------ if Yes,type ---------------------------- ' P IPlat 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,) { ` ASEPTIC TANK:[ ] -------- Liquid Depth --------------------------- W ' PACKAGE TREATMENT [ 7� h.. ., Type Size Material------- --------` - -No. Compartments - "1 Capacity ------------- YP I- ' h Foundation = Prop. Line i Distance to nearest: Well ____________ _ --" 1— Length of each line--------------------- ------ Total Length ------•--------•------- LEACHING LINE [ ] No. of Lines _._.---- -� '� _ Type Filter Material ___________________Depth Filter Materia i -.D' Box =�----- - YP ll D-istar ce to nearest: We Foundation ------------------------ Property Line ------------------•----- SEEPAGE PIT [ ]. Depth-.--- --------- ----- Diameter ------ Number ---------------------------- Rock Filled Yes 0 No 0 -�—�_ = --- --------Rock Size ------------------------- t WateYNTable Depth ------------ 4 ------------- .4 ' ' I -------Foundation --------------- ---- Prop. Line --- Distance to nearest: Well --------------------------•----•- I' i •----- Date --------------------------•-------) 1tEPAlR/ADDITION(Prev, Sanitation Permit - _ --� ------------ ------=------------- Septic Tank (Specify Requiremen ts) ------------- - ---------------- ---------- Disposal r Fielecify" Requirements f .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 R r County Ordinances, State La{ �and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies thefollowing: person in such manner "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any p 1 as to become subject to Workman's Compensation laws of California." Owner Signed --- -- -------------------------------------------------- ------------ __ -------- ------ Title --- ------------------------------------------------ ------- ----------- - - - - - ----------------------- ------------------------- (If other than owner) F R .DEPARTMENT USE ONLY DATE "^f APPLICATION ACCEPTED BY ----_--- DATE ----------------- ------- BUILDlNG PERMIT ISSUED ______--'-------------------------- ------- ------------------------------------------------=------------- ADDITIONALCOMMENTS ------------------------------------------------------------- ------------------------------------ ----- ----------------------------- ------- ------------------------------------------------------------------------------------------------------------- - ------------------------------ r ------------I----------------- - -- ----.Date -- -- --`- - ------------------------------ Final inspection by- ------------------ - - --- --- --- --- SAN JOAQUIN LOCAL HEQ,�TH DISTRICT i . I - F- H. 9 1-'b8 Rev. 5M