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FOR OFFICE USE. APPLICATION FOR' SANITATION PERMIT f........_ty,..�.... ...........................•---..... Permit No. _.7 - (Com lete in T.i licate) �:___._'""•'••--. p p This Permit Expires I Year From Date Issued Date Issued ._.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 C unty Ordinance No. 549 and existing Rules and Regulations: p� J013 AQQRi:SS/LOCATION ,.. .D.--••- ......................CENSUS.TRACE' ................ Owner's Name .. .. .. . .!�f..ti...4�k ' .1 xk.i;�..... .. / ..__. .� .Phone . ... .. Address .. $. .._ r7_/.t T ...._ �J�d C�4R-1------•--------- .............. City ............ ...........••---•-........ I Contractor's Name ...............J.A 4.E--......-----------------------------------------------License # ---•------- .--------_ Phone .........I................ .... Installation will serve: Residence &Apartment House,E] Commercial ❑Trailer Court i❑ Motel ❑Other ...................----•---_-... Number,of living units:.......I-- Number of bedrooms ___-_-Garbage Grinder ............ Lot Size ............... Water Supply: Public System and name ..... G1 -�.�--• ..........-............................................•...... PrLvate ❑ Character of soil to a depth of 3 feet: Sand ❑ :Silt❑ Clay ❑ ' Pea't❑ Sandy Loam ❑ Clay Loam [] "Hardpan ❑ Adobej4 Fill Material*----------- If yes, type ._:•----------------•------- (Plot plan, showing size of lot, location of. system. in relation to wells, buildings, etc. must bi -.Oaced on "reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 206,feet,I f. PACKAGE TREATMENT E ]i SEPTIC TANK,t ]l Size................................................. Liquid Depth .......................... �. Capacity ---------- ......... Type .................... Material--------------....................... No. Compartments Z Distance to nearest: Well ....................................Foundation ...._................. Prop. Line ...................... LEACHING LINE ] No. of Lines ........................ Length of each line............................ Total length� W 'D' Box __- Type Filter Material ....................Depth'Filter Material ..r—...... Distance to)nearest: Well Foundation'£ yProperty Line ; = — ;,` : 4V SEEPAGE PIT [ ) Depth .................... Diameter ....... Number ..............._.._......... Rock Filled Yes ❑ - No-0 ¢. Water Table Depth `Rock Size....�;..�--••---•---... p ------•----------- ----•--•-...........•-•---... ................... E 'P Distance to nearest: Well _..._._._...I...........................F undation.____:.___...'_...... Prop. Line ....... , 1r \ . REPAIR/ADDITION(Prev. Sanitation.Permit#................ Date Septic Tank (Specify Requirements) ---------------------:• `� ------..6.......................... . .... p ^.._.._ w._ f Disposal Field (Sp cify Requirements) :--- F�.dh--.-�.`f - - --•' ---------. IGS ,Ir -----. ...... __.. . -. . ......... � F = (Draw 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 l County Ordinances, State laws, and Rules and Regulations of the San Joaquin Local'Health'Dlstdct. Home owner or licen. sed agents signature certifies the following: "I certify that in the performan a of,th fork for which this permit is issued, I shall not employ any person in such manner as to become b' ct to W cm Com ensation s of California." " + M I Signed A. Owner . ---•-- -- -•-----••----------------------•-•--• . :.n. BY Title __ ___ (If other than owner) ! F R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ...... . DATE _....- - 7 ._...._. BUILDING PERMIT ISSUED ... ------------=------------•--......:.."......... ..._- = 'f ........DATE ..... .... ....... ADDITIONALCOMMENTS ............................M....'--•- •-- --.....------•-•--.....-----•... -------- ..............................................I........................... -----•-------------•-- .. .....:.......•••-- ..... .........................--••--....._...._------....... ........... •--••_. .......................................-............•• ---- ---- --................. _ Final Inspection by: ...... .... :._. . ... ...............................................•------. --.. ate ....... ------ SAN JOAQUIN ,LOCAL HEALTH DISTRICT E. H. 13 24 1-'6$ Rev. 5M 7/77 3 1 k iL__�-