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"a`O-R OFFICE_ . -.USE. . : ..•----.. �� • APPLICATION FOR SANITATION PERMIT 7 Permit No. . 7/. ...._......._..:... --.-. .._... . . . ........ _ .7 ......__. .. ....................... (Complete in Triplicate) .. ...................... This Permit Expires t Year From Date issued Date Issued Y'_-�_.'-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 County Ordinance No. 544 and existing Rules and Regulations: JOB ADDRESS/LOCA�1 N ., � � ; / Y ........ /� :.�_. . /9.A<............. .CENSUS TRACT Owner's Name . ---. . ..�-: Phone ...:..... a Address . /.%V.p. ..lY....a_... -.q ; .. .r /V. f -E• .. City %��.J>.. .. I .................... Contractor's Nome ., 1719.�_C U.�._...�,�_7..}` � -_---._...-.License # Phone Installation will serve: Residence Apartment House C] Commercial ❑Trailer Court a Motel ❑Other .................:.......................... Number of living units:... ........ Number of bedrooms ._Q------Garbage Grinder ............. Lot.Size ... Water Supply: Public System and name _.---------------------------------------....------_ ----.---------_---.-.-------._---- ------_--------_-Private [�]/ Ch raster of soil too depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam C] Cloy Loam d �" _ J Hardpan ❑ Adobe ❑ Fill Material ... ........ If yes,type ... r (Plot plan, howing size o 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 avaable within 200 feet,} PACKAGE TREATMENT' [. i SEPTIC TANK Size......... r '-�` -•- Liquid Depth --.......................� Capacity/ 4v- PType ..................... Ajlaterial No. Compartments ... .....------- 1 Distance to nearest: Welll- - ---._.,--.---_Foundatio Prop. Line ....___.... f? ...... .._ Od LEACHING LINE No. of Lines Length of each lin ....._V....... Total Length .__:,f.� .............._. . ..... 'D' Box -_� Type Filter Material��._ .__...._.. Depth Filter Materia! .........2_y------------------•_---:-•- Distance to nearest. Well ........... Foundation Foundation ....-. Property Line SEEPAGE PIT ( j Depth .. .. .... ......... Diameter. ------ ......... Number ................-'_-. .... Rock Filled Yes ❑ No 0"n F �/ Water Table Depth ---- ---------------------•.........------------Rock Size ....._ . .......... Distance to nearest: Well ..:.......................--------------_...Foundation ........ Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# --.----- ------................................ Date ---------:--------.-----------..--) Septic Tank (Specify Requirements) .... ............._............-.-..-----._..--- ------ --------................------........... ................ Disposal Field (Specify Requirements) .........__------------------------------------------------- ......__....... ----- ------------- ..................._..... . ........... ................ ....... ........ ................. ................ ---------- ------- .............-.-.................. ----- ..._._. (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 certify that ii the perform nce of the work for which this permit is issued, I shall not employ any person in such manner as to beco a su jest to or —an's Compensation laws of California." . Signed ................................ .......... . . .. Owner . Title `'v ._... ..... (If other tha wnerl IE fOlt DEP ENT USE ONLY ' APPLICATION ACCEPTED B DATE ... .7.�.5"7Y-..-..-.--••------ W_ _ BUILDINGPERMIT ISSUED _,......'................ .---•• •--- ------- -..----- ..... DATE ...._ ._................._._...._........._. ADDITIONALCOMMENTS ..... -- -•------- ----------------- --------•---.........................----------------- ...._....... ...... ------- ------.........I...... ........ .........••---.._.-._------ ----- ------------- . ............. ----..__..-----------....--.:.. ------------ ------. ` ......_. ------- I Final Inspection by: ....... •. - - ---------------Date ..� ...r:......... SAN JOAQUIN LOCAL HEALTH DISTRICT Rev. 3M -