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` FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT c7 Permit No. ��-�---r-6-�- ------------------------------- {Complete in Triplicate) ----------------- --------------"-- Date Issued - This Permit Expires 1 Year From date slue - -------- ----------------------------------------- - ---- it to construct and l the work Application is hereby made to the San com Pian eLocal h County District Ordinance Nom549 and existing Rulestalnd Regulations:described. This application is made p ... r��._. kcaccs------------------------ ---------CENSUS TRACT JOB ADDRESS/LOCATION ------��J9_3-----�� ------_ ----Phone.-------------------- ---------------- Owner's Name b�E----- - -ci' ------------- g �A l��O�. tQ `iL J,i. ------------------------------- City - :r— ---------------- -- Address ------------- -- -- Contractor's Name ---------------- -=---- ------`--------- --------------------------------------- -- ----License # ------------------------ Phone ----- ------------------------ installation will serve: 9 Residence Apartmem House'❑ Commercial ❑Trailer Court 0 Motel ❑Other -------------------------------------- Garbage of living units:-_�`------- Number of bedrooms _8'3-Garbage Grinder ___' _ _<Lot Size __--"-- ----------Privat Private E�-- Water Supply: Public System and name ----------------- -- Clay Loam ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Y • � i Hardpan ❑ - Adobe'Fill Material ------* -..If yes,type ------------- -------- - r buildings, etc. must be placed on reverse side.) ; (Plot plan, showing size of lot, location ofsystem "relation to wells. (No septic tank or seepage pit permitted ed ifpubiic `ewer is available within 200 feet] NEW INSTALLATION: Liquid Depth _-�"�--------•--•--• W S�PTIC TANK[ _ �� PACKAGE TREATMENT [ � � 5ize-------------'---------��-- - ------ - q p �p�C-� ____-- Type _ _--p-C1 - --- Material_-eU)— --- No. Compartments ----�:-----•----- Capacity -- ------ YP t° Distance to nearest: Weil ---------"-'-------------------------Foundation -----JP----------- Prop. Line __—-- -----•----- 4 t0)------!) ----- Length of each line.--------�0------------- Total LengtkP-)----a79..------- LEACHING LINE [ ] No. of Lines (10) ----- 'D' Box ---- --- Type Filter Material.. . -=-•Depth Filter .�,. PropertyLine ----- -- I Distance to nearest: Well -- Foundation ""- SEEPAGE PIT [ ] Depth ------------ ------ Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No i❑ ---�— ------------------------------------------------Rock Size -------------------------------- 4 Water Table Depth ------••-------------- Distance to nearest: Well ----------------------------------------Foundation ------------------- Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# -••------ ------ ------- Date ------ ---------------------------) Septic Tank (Specify Requirements) ----------------- --- -------------------------- - ------------------------ Disposal Field (Specify Requirements) ------------ ' - ----- --- =- ---------- ------------------------------------------- (Draw existing and required addition on reverse side) 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 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 as to become subject to Workman's Compensation laws of California." E Sign 7 -------- --- 4 ------- --------------- --------- Owner a �1.-/�✓LG ------------- --- -------- Title it a ----------------------------------- ----------------------- (if of r than owner) FOR DEP NT ON Y �.-' -" 7 ------------------- APPLICATION ACCEPTED BY ________-.______- ---- -------------- -- -ice ----�` --------• DATE __.-�-- BUILDING PERMIT ISSUED ----------------------- -------- ------------ ----- -,-- - -- ------- --�---- ------ -DATE -----------------------------------•---•�_. ADDITIONAL COMMENTS ---------------------- -------------------------------- - -------------- -------------- - --------------------- ------------------------------------------------------------------------------------------------------------------- --------------------------- - �_ --- --- - - ----------------- ------- ------- ---------- -------- -------- ----------------------- ------ -:- --- - -------- --- ----------------- ---------------- - -- Final Inspection b -----""--""-----`-"-"""`""- ------------- ----------------------- SAN JOAQUIN LOCAL HEA DISTRlC7 C r- H 9 1=68 ROV. 5M