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FOR OFFICE USE, APPLICATION FOR SANITATION PERMIT / ......................................:::.............. Permit No. 7� oW. (Complete In Trlplltatel This Permit Expires Year From Date Issued Date Issued /4 7 A f Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application Is made In compliance with County Ordinance No. Sag and existing Rules and Regulations: ® Ay 04- .SOB ADDRESS/LOCATI N�. �3 . ,(! CENSUS TRAGI Owner's Name .. ..G. l: ....... .. .- �2.--. .......... .............................h_......Phone .................................... ``.... x�ddress ................--........ . .. ...... _..__.. L__ ._... r.._..........City .........................................._...---•----......_............... ] Contractor's Name ..License ..... Phone .............................. Installation will serve, ri -Residence N-Apartment.House.❑.Commercial❑Trailer Court ❑ Number of living units:.... ------- Number of bedrooms .3..... Grinder ....... .. Lot Size ...................... Water Supply= Public System and name ........:....r..................... ir.................Private❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑,-- Sandy Loam 0 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.m NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feet,l PACKAGE TREATMENT [ ] SEPTIC TANK f i Size- ........................ Liquid Depth Capacity................... Type... .......... Material....................... No. Compartments ...................... Distance -to nearestz Wel- .::.............:... ..Foundation ... Prop. Line -I ACHING UNE [ I Na. of Lines ----... ........ Length of each line.... ........................ Total Length ............................ 'D' Box ........:... Type Filter Material ....................Depth Filter Material ...........................................� - , Dlittance to nearest, Well ......................... Foundation ........................ Property Line ......................� SEEPAGE PIT [ Depth -'+ Diameter ..Rock Filled Yes ❑ No ❑ WaterTable Depth ................................................Rock Size ................................ Distance to,nearest: Well ........................................Foundation .................... Prop. Line ...................... REPAIR/ADDITION IPrev. Sanitation Permit# ............................................ Date ............----..................) Septic Tank (Specify Requirements) ........... . -... ... .............. ... -j� ..,........... Disposal Field (Specify Requirements) .. �•- - . _ —.4.: t.....' 1:[.l .►.� ................ ........................:............• ....a..�:.. . . .......................--.....---.---.....................----........... . .......................................................................................................-...................I......... .... .... --.............-....- (Draw existing and required addition on reverse sidei I hereby certify that I have prepared-this.applicatlon.and that, the work will-he done In accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San :Joaquin Local Health District. Home owner or 11cen- 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." gnec --------------- - ------ - -•-------- --- . Owner i By a 8 ..... ...... itle ...................................................... (if of er a ..owner) FOR DEPARTMENT USE ONLY - .. DATE .f. ..�� APPLICATION ACCEPTED BY ... --._-- --- ............:............: BUILDING PERMIT ISSUED DATE- ...............................-------......_....... ADDITIONAL COMMENTS ...... ............................................................ .......................................... _._............................--......... .._.. ....... ....................................................•----..........--------._....._........... ...............----........ ...... , . ............... ...... ...... ...... _...-_._._..--------...------........................................... ..... Final Inspection by. --. Date .� ...�� .................. EH13 2h i-b£3 lay. ��---------------------------------------�..�.__......._._...- --- �--._......... SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M i