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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ................ Permit No. .7 (Complete in Triplicate) ..-... This Permit Expires i Year from Date Issued Dote issued .......�s. � 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 'y ._...aj. .... • �•.�. v...� ��.�.�.`� .1...�..J]. ....._._.,. — ...� .�.. � r ` � � R^e..g�u.latiEopn s : � : • 1 .-.... CENSUS TRACT 421-01. .JOB ADDRESS/LOC ION I: .__. -.... . Owners Nam . ............... . ... .Phone .�......... .. GtY......... ��Address . ......... .... .....F Contractor's Name �.'..............'..License _.. # ......Phorie Installation will se a-^, Residence�artment House 0 Commercial❑Trailer Court ❑ � Number of living units ......... Number of bedrooms .,, G � Mote Other ............... r � -.... arbage.Grinder ............ Lot-Size .-�-��..Q�'..�r.-�............ Water Supply:'Public System and name ..................----------.................;...................:.............-..............................Privateer a Character of soil toa aepth of 3 feet: Sand'❑ Silt 0 Clay eat❑ 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:{ (Noseptictank or'seepage pit permittedif publit sewer is available within 200 feet,} PACKAGE TREATMENT--4-] --SEPTIC TANK{ ] Size........... ............................ q p Capacity-=._..7:n.... Type :7_-_ Materia[ :,___....y.:_. No. Compartments ................. 'Distance to nearest: Well ...................................Foundation Prop. Line LEACHING LINE { J No. of lines - FLength of each Fine_______________________ Total Length - -'D'-Box'----.'-;7: . Type Filter'Material"'"r''`°"".:. Depth Filter Material ..:....:::.:............................... . ' Distance to 'nearest: Well,:. Foundation . Property-Line ' SEEPAGE PIT j j Depth Diameter .....::........ Number ...............-............Rack Filled Yes ❑ No i❑ Water Table Depth ...Rock Size Distance to nearest: Well '` ...................Foundation .....y Prop Line REPAIR/ADDITION(Prev. Sanitation Permit# Lam`.... Date . ) Septic Tank ISpecify Requirements) ................................ = •--- ....••---••..:--- ---.----- Disposal Field IS Requirements) .._,._•-- ---____ �'� 1. G.-.-- - •_. � �. ._.____ �� /� ........ ---------- ---_ ----••••-• 4.1 .................. { ..-~~ _ ....-.. ..-..... . ` ._.._.....__................_.. ................................................ I ..................••--------•-------._.._ ----------------------------------------------.:.--_............................................... ------ --•---- .......... ...... r , (Draw existing and required addition on reverse side) y . 1 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 Regulatiani'of the•San Joaquin,Local Health District.Momo owner or licen-sed agents signature certifies the following: . .. . - - ! "I certify that in the performance of the work for which this permit is issued, 1 shall notm eploy any person in such manner as to become subject t Workman' "Compensdtiod'laws'of`California. . Signed � • � � Owner 00, t By .._.... :......:.........:... Title �1�._.._�.._....��c other than owner) .r FOR DEPARTMENT USE ONLY. I APPLICATION ACCEPTED BY ...... ....:...... DATE .. . .. 3 BUILDING PERMIT ISSUED .................................................. ... . .._.._.... ----------•-------------------- ....................................:..............DATE ......=..............=.................... . ADDITIONALCOMMENTS ....................:......:.................................................-- - •-:---••---••----...--••-•--.......:--••-•--••-_--:..----._._.._.............. -------------------------------- --------------•-•--•--._..... .:..._...--•-------------------------••--------------••-------•----=--•---•---------- ------ ...........I...-•-•---- ...:..............:: :. Final ins ection b lit° ...Date � ................... P Y: SAN JOAQUIN LOCAL'. HEALTH DISTRICT E. H.Y3 24 1.'68 Rev. 5M 7/72 3 LK