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FOR OFFICE USE: f ! APPLICATION FOR SANITATION PERMIT' .............................-_ T'..�t-..�.. Permit No. 7S / v. ....... (Complete In Triplicate) 71 .................... This Permit Expires I Year From Vete 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 No. 544 and existing Rules and Regulations JOB ADDRESS/LOCATION ...... ........ ............._..............CENSUS TRACT ................ ........, Owner's Name ....... ..................................................Phone . ��' � ....... Address ................ � . ............... City ....................... . ......... ..... Contractor's Name ..... . r-.-- ,• "e< .................License �� c l.. Phone��a—s-� .. .. Installation will serve: Residence Apo rnent House 0 Commercial QTroller Court 0 Motel[]Other............................................ Number of living units:........ Number of bedrooms --:,-....Garbage Grinder .... ....... Lot Size _7 .-z 3:......... . Water Supply: Public System and name . - , . f f ,. ..-----......................................................Privato Q Character of soil to a depth of 3 feet: Sand o Silt o Clay a Peat❑ Sandy Loam o Clay Loam Q 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 available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK€ I Size................................................ Liquid Depth .........................` Capacity -•-••- ............. TYPO •------------------- Material...................... No. Compartments ...................-l" Distance to nearest: Well ......Foundation ......... Prop. Line LEACHING LINE [ ) No. of Lines ........................ Length of each line............................. Total Length ..........................,. 'D' Box ............ Type Filter Material ....................Depth Filter Material ........................................... Distance to nearest: Well ........................ Foundation ........................ Property Line ........................- SEEPAGE PIT { [ Depth .................... Diameter ................ Number ............................ Rock Filled Yes ❑ No 0 Water Table Depth ----••-•--•.....................................Rock Size ................................ Distance to nearest: Well ........................................Foundation .............. Prop. Lino ....................�/'„ REPAIR/ADDITION(Prev. Sanitation Permit# ...-.....--.-------------------------------- Date .................................. Septic Tank (Specify Requirements) ............................................................................................... .............................:......... .. Disposal Field (Specify Requirements) .... ....! 4 ._- _.. ...... i. ... -•--------------------••------•------•-•-•------------ •----------•-••-•-•--••----••-•-•--•----•--•-•---•-•----•---•••-•-•----------------...-----..............------.......•---,........................ ----------------------------------------------------------•.._...--•---._.....----......•-----------------.._._...----------•-------------...........---.........-----•----.................-••--•....... (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 "*" District. Home owner or licen- sed agents signature certifies the following: "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 ...................... Side If other than owner) IG��` 7 R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . . r.. :< 0 = ,9 DATE . ." �j�...:.._. BUILDING PERMIT ISSUED . .. - DATE ................. ADDITIONAL COMMENTS :.. . --- - -------.......................................... _. ................ ........................................................ -- --- . . ....-- -.-.....---.-x---.,_.1. .1._(,l.. .................. ---- --. f ---Final Inspection by: ................ ----- . ----- .. ... Date ... EH 13 zh' Rev:' SAN JOAQUIN L L HEALTH DISTRICT 8/711 3M