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FOR OFFICE USE: APPLICATION FOR-,SANITATION PERMIT Permit No. -?-7i (Complete in Triplicate) - �- Date Issued _. _'1_ j7/. .. This Permit-Expires !_Year From Date Issued . Application is hereby made to the San Joaquin Local ;Health District for a permi# tognstruct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ----- - -----i---CENSUS TRACT --- --- •Owner's Name .........6 ----------.-- f- c'___r --------------- ------- - -- = ------- ------------ ----- one = ------------------------------------_----- 'Address _.. Q,--,0W-c5s-- - -- ------------------------------------------------------kCity -yam ---------- ;.�• _ .. ' -=-------.License #agy/t - Phone' Contractor's Name .. ___ f Installation will serve: Residencer.Apartrnent House�❑ Commercial []Trailer Court ;❑ Motel [:] Other ` ------------------------------ ----- =- ' CV Number of living units.-Number of_bedrooims #- ----Garbage Grinder Lot Size/lt - --ftp-0 ,. Water Supply: Public System and name ----------°----`f' ----------•---:-- ----- ----------- -------------- : ' Private Character of soil to a depth of 3 feet: Sand ~Silt❑ Clay ❑ Peat'[], Sandy Loom ❑3 Clay Loam ❑ Hardpan Q" Adobe Fill Material ___ 1f yes, type ----;-,-7 (Piot plan, showing size of lot, location of system in'relation 0 wells, bldiigs, :etc: must be placed on reverse side.) rA NEW INSTALLATION: (No septic to rikior seepage pitl permitted if public sew.er'ii avail labhe w.it iin 200 feet,) V PACKAGE TREATMFN7 { ] SEPTIC TANK[ ] *s�. Size------------------------- --- Liquid Depth --------------:----------- Q = r ,f ------- Ca acit __ No. ClOmpartments ------_-.. - � �_,...p Y -_ ,�- , ---- Type = Mat rias Distance to nearest: Well-. '''• _ Foundation ------------------ Prop. Line ------_-------------- . -_---_ LEACHING LINE [ ] No. of Lines -----------------7------ 'Length of.each.-line.---=----------------------- Total Length ---------------------------- .�. 'D' Box ------------ Type Fi a :.b terial --------------------Depth Filter Materia ------------------------------------------- ll Distance to nearest: Wtell _.__1_ _________________ Foundation -------------.---------- Property Line --_---_____.._---------- SEEPAGE PIT { ] Depth�affillt/Depth ". ----------""-- ;jDiametir- ---------------- Number .---------------------------"Rock Filled Yes ❑ No i❑ j Water -------------------------------------------------Rock Size -------------------------------- Distance to nebrest: Well ---------- -----------------------------Foundation -------------------- Prop. Line _. ...... REPAIR/ADDITION(Prev. Sanitation Permit# -•------------------------------------------- Date ---------------------------------- Septic -----•----------------Septic Tank (Specify Requirements) -------- - ----------------------------------------------------- -,;- -- --------------- -------- Disposal ------Disposal Field,(Specify Requirements) ------�f --- ------------------------------------------------------------------------------------------------------------------- r `---------------------------- F {Draw existing and required additions on reverserside) 1 hereby certify thatI have prepared this application and that the work will be done in accordance with-Son Joaquin j 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: ,. "1 certify that-in the performance-of the`Work•for which this-permit-is--Issued, Vsholl,not-employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ---------- --- --- ............. ------------------------------------ Owner .A, ` Title -. ' �--------------------------- -- -- . --------------------------- -- other than owner) E #4 FOR DEPARTMENT USE ONLY — 77 ------------ � 'APPLICATION ACCEPTED BY . �-R40--- ------------------------------------ - -----„----------- ------. DATE / , BUILDING PERMIT ISSUED ----------------- ------- --------------------DATE --- --------------------------------------- - -- ------------------- ADQITIONAL COMMENTS -------- ------------------ --- -- - --------------------------- - -------- -- -- ------------------------ t ------- -- -- --------------\--------------------------------- ------------------------------------- .. -------------------- -------------- ------------------------------------ ------- - -------- --------- --- ------ - ------------------ ----------------------------- --------- ----- ------- - -- -------------�.r ' -- - Final Inspection '- -------------Date ------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H."9 � '.i`1268 Rev_ 5M.