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FOR OFFICE USF: APPLICATION FOR SANITATION PERMIT ------------ - ------------- ------- Permit No: 7Z--- - --------------- Y°...- _ (Complete in Triplicate) ----------I------ --------------------------------------- p. / i 7 � IDate Issued �:-------�--___.. ---------------------------------------_------------.--_ This Permit Expires 1 Year From Date Issued 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. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION _ C� _ -- � ��SUS TRACT ---------------------_-- Owner's Name ---------- ---Phone ----------•--------------------••--- i— aeAddress ----- 1 '� � �, .J fi ------------------- City ! t"f Contractor's Name-=��G'f ---------------------------- ----------License # f9 Phone Installation will will serve: Residence%Apartment House❑ Commercial []Trailer Court ;❑ MotelOth Number of living units:_._ ----- Number of bedrooms � r/� ❑Other --------------------------------------------, --____Garbage Grinde __ Lot Size "- �-1--• __ Water Supply: Public System and name -------------------------------------.----------------------------------. ---------------------- _Privateo Character of soil to a depth of 3 feet: Sand' Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ I 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is E ailable within 2bs feet,) . / q � . / PACKAGE TREATMENT [ ] SEPTIC TANK [ Size__/ X_�---J�-------------------- Liquid Depth - ----I Oq Capacity 42M------- Type ----- Material 4011&--------- No. Compartments ----Z-1 QQ Distance to nearest: Well v -mss/____ - ----------------------Foundation -le-------------- Prop. Line !/`_____-__--__ LEACHING LINE �Q No. of Lines ___2______----------------- Length of each line---;�----------- ------ Total Length 1_��---------------- < . t01 'D' Box �1�_-" Type Filter Material ?AVZ r'___Depth Filter Material Distant tc nearest: Well -6,40 ---------------- Property Line _ ----------- -------- SEEPAGE PIT [ ] Depth -------- -------- Diameter ________________ Number --------'--------------------- Rock Filled Yes ❑ No Water Table Depth ------------------- ------ -------Rock Size -------------------------------- Distance to nearest: Well --------------------------- _____________Foundation -------------- ---- Prop. Line .-.------------------- REPAIR/ADDITION[Prev. Sanitation Permit# -------------------------------------------- Date ------•.--------------------------) SepticTank (Specify Requirements) ---------------------------------- ------------------------------------------------------------------------------------------------------- DisposalField (Specify Requirements) ------------------------------------------------------------------------------------'------------------------------------------------- ------------------- = = i . . ! (Draw existing and required addition ----------------------------------------------------------------------- ------- --- - dition 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 "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 ` - ----- Title ----------------------------------------- - ------------------ -- - (If oth an owner} FOR DEPARTMENT USE ONLY f ` APPLICATION ACCEPTED BY _.-LtJ------------------=----------------------------------------------------------------------- DATE ----------------------- BUILDINGPERMIT ISSUED ---------------------------------- ----------------- 4--------------------------------------------------DATE ------------------------------------------- ADDITIONAL COMMENTS -------------_---------------------� - �' -- ---- -------------------------- --------------------------- --- ------------------------------- ------- -----------=------- �' �^ ' " Date f -j---'�------------------- Final Inspection by: ------ ---------------------------- �= F l SAN JOAQUIN LOCAL HEALTH DISTRICT r i E. W 9 1-'b8 Rev. 5M