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FOR 6FFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ,p ....... (Complete in Triplicate) Permit No..7 Date Issued.„3:5.:�, ............. ........ - -- . --- -- ........ This Permit Expires 1 Year From Date Issued Application is hereby made to.the San Joaquin Local Health District for ct,permit to construct and-install the work herein described. This application is made in compliance with County rdinance No. 49 and,existing:Rules and Regulations: JOB ADDRESS/LOCATION. E ACT ........ .. .. .. ..._ F SUS Owner's Name .: c�7�i . -- -- - -- -- ;.Phone................. _------------- Address_.... Address T .. . .; --•- 7 f( .. --. cit - .... --------- Contractor's . .. r!7� __Zip_.. .. Contractor's Name-.--_ -!f G - - License #_ _. :. ... - .Phone__a , Installation will.serve: Residence Apartment House ❑ Commercial [] Trailer Court ❑ Motel ❑ Other....... ...... Number of living units:........1.._. Number of bedrooms.... Garbage Grinder............Lot Size...... .---74.A.._ --- Water Supply: Public System and name._ .....-:.. ------ .... ..... . .......Private Character of soil to a depth of 3 feet: Sand FISilt❑ Clay,❑ Peat E] Sandy Loam ❑ Clay Loam ❑ 1 Hardpan ❑ Adobe❑ Fill Material - ...If yes, type.................... - OJ (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 200 feet,) PACKAGE TREATMENT [ ) SEPTIC TANK [ j Size ... . ........... .Liquid Depth:.__'_. Capacity.{-%W_ _0----Type.-4....... . .....Material...(^,, -- -----------No. CCompartments... --------------- . Distance to nearest: Well........1_ .P .. __ .: ._ V5........Foundation_..__. -_:_.. ...Prop. Line......---------------------- LEACHING LINE [ ] No. of Lines - - .....__ ----------- ---of each line.---.o>L�P..... ._.. ...Total Length .. Vz Q ._... ..... .. .... 'D' Box_ Type Filter Material.-. p �r ,. De th Filter Material...__.. _.;. � ...-.. Distance o nearest: Well -------- -----.Foundation.................. ----------Prop ty Line............. ..-...1 SEEPAGE PIT ( ] Depth............ ..Diameter........ Number _._ ------_-----_---_--- ock Filled Yes ❑ No ' Water Table Depth--- -----------------•- -- . . . ..._...-------:..._.Rock Size. --------------------------------------- Distance to ----- ----- .-.- --. .....- Distanceto 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 1 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 licensed agents signature certifies the following: "I certify that in the perfotmance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed :.._ .. _.. ..._. . --- -Owner B :.. :. . Title.---- •----... Y -? _.. (If other than owner) FOR DEP RTM T USE ONLY APPLICATION ACCEPTED BY.... 4- ---------____ -- .DATE .. :.-1"`... . .. DIVISION OF LAND NUMBER........... ...- ----- -- ------- ----- ------:DATE ---- -•--- . . ------- ADDITIONAL COMMENTS.------- ......... ------------------------------------ - ----- - --- - ..-----: ..•. -----..-- . .- Final Inspection by. .. :. -- .... . ...Date... 7hR.- eH 13 24SAN JOAQUIN LOCAL HEALTH DISTRICT Fss„2�Rev. ��q 3M