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FOR OFFICE USE:- :v_ APPLICATION FOR SANITATION PERMIT '. . 3_b = Triplicate) Permit No: -7- (Complete in Trip nate - ----------- --------------------------------- p 73'Y. - Date Issued This Permit Expires 1 Year From Date issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: tet/ CENSUS TRACT ------ ------- ----------- ' JOS ADDRESS/LOCATION __ - - -1 -- - _ _ _____________----------------------- Owner's Name ------------- ------.Phone _ _ .--------- - -- - - -------------------- City _._ ewI/4 , 1---------- ----------------------------------- Nr # - ------------- ---License #" Y Phone IContractor's Name . -- -. ' / ._ _,1 s -- -----------------�- �" Installation will serve: Residence W Apartment House❑ Commercial ❑Trailer Court Motel ❑ 'other --------- ------------------------------ Number of living units------------- Number of bedrooms -3-------Garbage Grinder ____---.___iLot Size �`J2C__JVP_-�------------ Water Supply: Public System and name _____------------------- Private Character of soil to a depth of 3 feet: Sand'❑ Silt[-I 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 iivells, buil"dings, 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 f j Size------- � __ 'r� l Q-------- Liquid Depth _/,--�----------•.- --__"- T ' 'Materialf _ Na. Compartmen#s __ '1"-- : ••• Capacity - yp .. Distance to nearest: Well ___- - -------------- ---Foundation -----L`Q__. _____- Prop. Line �3 ...� LEACHING LINE I j No. of Lines ___-Z- ------------- Length of each line__._70---------------- Total Length ,_______- ....... isP _ Depth Filter Material - -- -----------•----••- Q D' Box .___----_.__ Type Filter Material ---- -- p Distance to nearest: Well --------- Foundation /_d--------------- Property Line __<----------.-.----- e th Diameter Number Rock Filled Yes g No 0 DP 4 SEEPAGE PIT [ ] -- ------- F Water Table Depth ----------------- -------------- - -------Rock Size ---------• ] Distance to nearest: Well ------------------------------------------Foundation --------------- ---- Prop. Line -----------•---------- REPAIR/ADDITION(Prev. Sanitation Permit# ---------------- -------------------------- Date -------------------------------•--} ------------ Septic Tank {Specify Requirements) ----------------------------------------------------------------------------------------------------------------------------- Disposal Field (Specify Requirements) ------------ ---------------------------------------------------------------------- _ - --- --------- P p - (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 Sari Joaquin h. 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 shall not employ any person in such manner I as to become subject to Wor man's Compensation laws of California." Signed __.._ Owner ---------- ------ Title ---------- --------------------------------------------- -------------- (If other than owner) FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - ------ DATE ---- - -------- BUILDING PERMIT ISSUED ---------------------------------- ------------------------------ --------------DATE - ADDITIONAL COMMENTS ---------------------------- - - ----------------------------------------- -- -- --------------- ----------------------------------------------------------------------------------------------------------------------- -r�- ---- --=------- ----------------- Final Inspection b Date PY� ----- --- ---- ------------------------- SAN JOAQUIN LOCAL HEALTH -DISTRICT {� E. H. 9 1-'b8 Rev. 5M