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FOR OFFICE USE: _ APPLICATION FOR SANITATION PERMIT (Complete in Tri -I - p p icate)- Permit No. Y -----.--__--__----_- This Permit Expires 1 Year Froin bate Issued Date Issued .--5 --7 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 Cbunty Ordinance No. .49 an' .existig u es and Regulations: JOB ADDRESS/LOCATION - __4-.6.(--- _ _- _ _ -_ f ---------------------CENSUS TRACT ---------------- --------- Owner's Name 1 =------ -- ----- - -----------•- -- = r Address --------- � `��' ------y-------------------Pty _ Contractor's Name --.; License # t� Phone 1�0 Installation will serve: s _Res dente ❑Apgrtm nt House❑ Commercial-: Trailer Court ;❑ Motel Other ------------------------ 1 x� Number of living units:-.1-7_ -Number of bedrooms-1-7-_--Garbage Grinder ------------._ __-- Lot Size ------- _- _---- Water Supply: Public System and name ------------------------ ----- -------------------------•-----•-----=-=j------= '•---------------.-Privates Character of soil to a depth of 3 feet: Sand'r] "Silt❑, Clay-f] Peat❑ '.Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe ❑ Fill Material ------------- yes, type ---------------------------- (Pl'ot plan, showing size of lot, location of system in relation to"wells, buildings,etc. must be `places! 'on reverse side.) NEW INSTALLATION: (No septic tank or.seepage pit,permitted. if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK:[ ] ++� ` Size---------------------------------------- --t'`_ Liquid Depth ------------------ -------- Capacity Type ---- cNo. Compartments P Y -- ---------- T e -- - ------------ Material------ --- -- ---------------------- � Distance to nearest: Well ------_--------------------="_`Foundation -..--------+-_'--_ _ Prop. Line -----_-----_-__.---.-- LEACHING LINE [ ] No. of Lines ------------------------ Length of each line---------------------_------ Total -Length -------------_--- 'D' ----------.-_--- 'D' Box .-------- Type Filter Material --------------------Depth Filter Material --- ------------------- ---.-.-_------_.--_ .11,-- - r -'.- . _ Distance to nearest: Well ------------------------_Foundation -------------- Property Line SEEPAGE PIT [ ] Depth -------------------- Diameters ---------------- Number __-_----------------------- Rock Filled Yes ❑ No 0 (7y Water Table Depth --- =_- - ''-------------------- ....Rock.Size ---- -------------------•- Distance to nearest: Well .------'*`------------------------------Foundation ------------- ------ Prop.TLine .- C REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date.---------------------------------_). Septic Tank (Specify Requirement ----------------�------ = . Disposal Field (Specify Requirements) --------G, - -- -----•--•1--- 0 ------ --------------------•--------._. -------------------------------- -------------------------- - _ y - _ _ (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 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 _ "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." Signed ---------------------------- Owner BY ------------ -- t ----------------------------- Title -------- �- 1- ► -- - --------- -- --------------------------------------------- (If of r an owner) 4 FOR DEPARTMENT U NLY APPLICATION ACCEPTED BY---------------------------------------- -------- -----= DATE -----11_-c )-2-----'0Q-------------- BUILDING PERMIT ISSUED ---------------± :-=---- = --DATE --------------- - ---- ADDITIONALCOMMENTS --------------------------------------- -------- ---------- ------------------------------------------------•------•---------- Er ------------------------------------------------------------------------------------------=------------------------------------------- -------------------------------------------------------------------- --------------------------------------------------------------------------- - J Final Inspection by: ---------------------------------- ----- --�}f Date � ---------- SA_N_ JOAQU.IN-LOCAL HEALTH WTRICT . E. H. 9 1-'6B Rev. 5M ,r