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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7 —g� S� ..... .................................. PermitNo. ... ... ............... .......... (Complete In Triplicate) .... This Permit Expires I Year From Date Issued 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 Na. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION r J:.... l....... ...... .. 1. .....-- .........CENSUS TRACT .......................... Owner's Name ._.,-�-..l =. ,�.. ..�� ..0 .. ........ . ........... Phone..................................... Address ................ , ...... City .... ......................... .. Contractor's Name U.:...._:.. ,Q.?? .....:...................................License � ... Phone ...... tJ........:SQ.( Installation will serve: Residence partment House 0 Commercial ❑Trailer Court ❑ Motel ❑Other __...••. . ---------------------------••-- Number of livingunits:...-.._.. Number o e oms Garbage Grinder ��. Lot Size ..._ ___ 9 .. 'l ' ••---• f Private Water Supply: Public System and name-.. ,.�........ .----- -----------------••----------........ ... ❑ Character of soil to a depth of 3 feet Sand Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ � n_ Hardpan ❑ Adobe 611—m* terial _14 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 available within 204 feet,) PACKAGE TREATMENT ) ] SEPTIC TANK J Size................................................ Liquid Depth .......................... 4 .Capacity .. yp ..... No. Compartments ............ ..............._-- Type ..-----------------• Material...-------------. ........... Distance to nearest: Well ;...................................Foundation ..............._.----- Prop. Line ............. 6 LEACHING LINE ( ] No. of Lines ........................ Length of each line.....:........................ Total Length ...__.... .................. D' Box ............ Type Filter Material ....................Depth Filter Material ._....................I..................... rn Distance to'nearest: Well ........................`Foundation Property Line ........................ SEEPAGE PIT O Depth .............. Diameter ................ Number ............................ Rock Filled Yes ❑ No C] • Water Table -Depth .....--^=-•-•...:....:.........:..............Rock Size --•........................... Distance to.nearest: Well ' �'"°° ...Foundation Prop. Line ......................�� y.....s......... 7,., . ..........T.. REPAIR/ADDITION(Prev. Sanitation Permit# ......................i..................... Date ...{:.:.........................) F Septic Tank (Specify Requirements) .......... ............... ... .._... ---- ... - -•----..._... Di posal Field {Specify Requirements) •-..---.1 -`---. _ .. --------------- _,/8 " .._.. -- ------- -------•- /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 lice*. 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 ..................... ...... ----------- Title ... ........ her than owner) FOR DEPARTMENT USE O LY APPLICATION ACCEPTED BY ....� ..........�.. ............................ DATE ...... ._...-__73. BUILDING PERMIT ISSUED ..DATE ----------------------------•--..... ........................ ADDITIONAL COMMENTS ...........:...........:. -•---------------------------- • . ........... .........._:................------------------... ----..................................................................... .................... .................... -------------- -- --- ----- ----- - •--_.... Final Inspection.by• Date .................... LOCAL -HEALTH DISTRICT �� 11 91A 7/79 'AW