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FOR OFFICE USE: ,APPLICATION FOR SANITATION PERMIT 7- �. --- � a k (Complete in Triplicate} Permit 7 � ------- Date Issued _-------- ------- 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 compliancewithCo rdinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATIO�yI �[�.� Iw ��-- / L _ � �'� CENSUS TRACT Owner's Nam --(--------✓/�&-`%- _//1- Phone ---------------------•------.-------- Address ------------ ------- / t___710--------------------------------------------. City _ --•------------------------------------------- ' ,_ Contractor's Name ___ ------ License # -_l�- ��-- Phone -. z� � Installation will serve: Residence Apartment HouseM Commercial ❑Trailer Court ;❑ ' Motel ❑ Other ---------------------------------------••--- Number of living units:----- ----- Number of becir s -`L Garba a Grinder w�__ Lot Size -.- -__---X_ -,----•-•---- Water Supply: Public System and name ---------- -------- -- - ---•-f-- - 1------------------------ -----------Private ❑ Character of soil to a depth of 3 feet: Sand Silt❑ Clay Peat E] Sandy Loam ❑ Clay Loam [3 F -- Hardpan E] Adobe ill Material/V-- If yes,type ----------__----.----__ - II (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,j PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size-----------------------------------•------ Liquid Depth -----_-----------.---.---•- Capacity --------------------- Type -------------------- Material---------------------- No. Compartments -------_---------= Distance to nearest: Well ------------------------------------Foundation - --------------- Prop. Line ----- ---------------- LEACHING LINE [ ] No. of Lines ------------------------ Length of each line---------------------------- Total Length _---.-_---_-- 'D' Box ..---------- Type Filter Material --------------------Depth Filter Material -------------------------------------------- Distance - ------------- - to ---_--_-------------------------_-------- Distanceto nearest: Well ------------------------ Foundation -------------______---- Property Line _______________--.-.-- i SEEPAGE PIT [ ] Depth ------------- ------ Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No WafterTable Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation _.------------------- Prop. Line ...-------------___-•- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---_-_-------------------.--------j . Septic Tank (Specify Requirements) ------ _ -------•------------------------ - --------- f Disposal Field (Specify Requirements) --------- ---- -----_--_-__---_----_ ----�-- : -1 -- ------------- ------------------------------------------------------------------------------------------------------------- ------------- -----------------------------=----------------------------------------- ------------------------------------------ -------- (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 kCounty Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. dome owner or licen- sed agents signature certifies the following: "1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." I Signed -- - -. Cfwner ' 0�- --------- ------------------- C0Title ' (If other than owner) I FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY ---7 - - ------ -- -- - -------- ----------------------------------------------- DATE _7-- ;�.-Y---------w BUILDINGPERMIT ISSUED ------ ---------------------------- ------------------------------- ----------------------- -------------DATE ---------------------- -------------------- ADDITIONALCOMMENTS ---------------------------- - ---------= ---------------------- -------------------------------- ------------------------------------ -------- --------•------------------- ---- ----------------------------------------------------------------------------------------------------- } ----------------- ------------------------------- ----------------- -- ------------------------------------------------ ---------------------------------------------- ------------------------------------ ------ ----- --��--}} ----------- ---------------- -------------- ------------- - -- - -------=-- ---- -------- ----------------------------- -------- ----------------- ---- ----- Date- ----------------------------- - ------ 7---- --- Final Inspection b SANJ AQUIN LOCAL HEALTH DISTRICT I E. H. 9 1-'b8 Rev. 5M