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r FOR OFFICE USE: '` APPLICAT{ON FOR SANITATION PERMIT /7 ,- Permit No. .-- ...--• _....i. -----•-••- ------ (Complete in Triplicate) Date Issued j This Permit Expires 1 Year From Date issued .............. Dp 2-SO- 5 Application is hereby made to the Son Joaquin Local Health District for a permit to construct install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: ,^- . _r. . Regulations- 7 JOB-ADDRESS/LOCATION JOB-ADDRESS/LOCATION . r° CENSUS TRACT .......................... Owner's Name __.._ Phone ........................... ....................... .. � Address ...... ....... . . City :............................ t -- Y. Phone _----------........ I Contractor's Name .- �...License # Installation will serve: Residence eApartment House❑ Commercial ❑Trailer Court 0 Motel ❑ Other ....-•--.._ •---•----- ` Number of living units: --- bedrooms Nbf Garbage Grinder ...... Lot Size _. ' f' `1 ......_..Private j Water Supply: Public System and name ----------------- ---- ------------------------------------ I .-..---- ---- Character of soil to a depth of 3 feet: Sand [] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loom } Hardpan F] Adobe ❑ Fill Material If yes,type ........... ......... ..... 1 ]Plot plan, showing size of lot, location of system in relation=to wells; buildings, etc. must be placed on reverse side NEW INSTALLATION: INo septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK-T } Size...........•--............... .......... Liquidp . _ i ...._ Material.---- No. Compartments ....--.....-•-••-.... Capacity .. .. .....---•-.. Type ................ . -- Distance to nearest: Well --- ---- ...........-------Foundation...........----_------ Prop. Line -------- ------------ Length of each line Total Length ......:......... ' LEACHING LINE [ ] No. of Lines " ..:. ... . g ....._.....� 'D' Box Type Filter Material ....................Depth Filter Material ............ ------ ---.._..-. Foundation ......-•---------------- Property Line _---.--.,.- Distance to nearest: Well _.._._...._- -_.�o. ❑ SEEPAGE PIT [ ] Depth ._I .' -------- Diameter ...----...__---` Numbe; Rock Filled Yes ❑ 4 Water Table De_pth.. --- -.'.-Rock Size ...---- ....-•-•.... ...:....... F T -------__1.---•--C Distance 'to nearest: Well ------------------------•.----•----.....Foundation Prop. Line REPAIR/ADDITION IPrev. Sanitation Permit# ---•---- ---- ---"• ------------ ........ Date ----------------- ......... i l Septic t / p YRequirements) eqe ents) ...... ..--------- ---- ------------------------------ .� �' .....__ Disposal Field (Specify Requ+cements) ..J . _.)11 _ . ` ---- --.._.. ..... ---- ------- --------- (Drciw 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 County Ordinances, State Laws,,and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen"r 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 as to become subject to Workman's Compensation laws of California." E i "- Owner Signed -----. •.. ............. ... ... ------•- ---- "` Title -?.. ........_.. (if other than owner) :.� FOR DEPARTMENT USE ONLY _ - -~ 1 _ ' APPLICATION ACCEPTED BY ":- . . . ------.......---------------- --------.:. . -----•---...-_........__.. DATE .. ... � ............-- BUILDING PERMIT ISSUED -".--" .� - -------------• .._._........ ....... ...... - ...DATE _.__..-- •. T. + ADDITIONAL COMMENTS ._._..._, r`- --. • -""-•................. ....... ..----- .--• ---------- ------------- -- -----•. .---• ........ -----•----- -- ........................-----•--" , ---•------ ---- .........-...........- •----- -__......... .. ----.._.............. S .�. _ ...._._. ......-._.. Final Inspection by ..:.................. ............... Date SAN JOAQUIN LOCAL HEALTH DISTRICT 7/723 W,4