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j FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. 7 -----�-�--- , (Complete in Triplicate) ` ---------------------------------------------- Date 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, Th��i� ap,p I,ic ion is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: ( c`aar7r�?d/�6vi S}a!�ev�iy. r. JOB ADDRESS/LOCATiON/�!` / _ f_ ' ��'��- ��`'�'a fi� G�t, CENSUS TRACT ------------------- ? a Owner's Name s , � 1t1 ',, _'o -�;----------•--- ---------------------"--------------- --------------------Phone �X �5 ` ; y Address City P,, i Contractor's Name __��/l'-- ' +�� / ------.Li�ense #rit' /s��1 __ Phone ; + F�� ----- Residence Apartment House' Commercial :❑Trailer Ceort K , Installation will serve: ❑ p ❑, Motel ❑ Other ------a------ ----------------------------- Number of living units:---/-__.__ Number of bedrooms __ _-___Garbage Grinder/ke---_ Lot Size 4?e¢� �-----------••--- Water Supply: Public System and name ------------------------------------Y--------------------------------------•---------------------------------.Private Character of soil to a depth of 3 feet: Sand'❑ Sift❑ Clay ❑ Peat ❑ Sandy Loam W Clay Loam ❑ " 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 s ewer is available within 200 feet,) PACKAGE TREATMENT SEPTIC TANK Size__*-X ---------------------- Liquid Depth .._ ! ---- [ a 5 : _ T e � Material Capacity -�--"-- yp��" -- - 1 -- ��' -- No. Compartments _�c-------------- Distance to nearest: Well ___ _-___;____________________Foundation _��_.__________ Prop. Line __ ------------- LEACHING ______.___ f LEACH WG LINE j(] No. of Lines,�l_4'1ot' j Length,of eacc��h��line_vW_X__l -� -- Total Length -v - -------------- 'D' Box r��_ Type Filter.'Material/,J fA e&epth Filter Material 1+ _________________________________ Distance to nearest: Well --- -------------- Foundation _,WO-__________"--- Property Line. ZZ7e------- SEEPAGE PIT `] Depth -------------------- Diameter -----z--------- N{umber ---- -----_ ❑ _________ Rock Filled Yes No '❑ Water Table Depth -------------------------------------------------Rock Size ---- ;----------------- r Distance to nearest: Well ----------- ------------------------ undation _------ r__-_t--- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# ---------- f-------------D e ___1---------------- --------------) t Septic Tank (Specify Requirements) _________________ ___________ s Disposal Field (Specify Requirements) - ----- -- ----------- --------------- --- ------------------------ :a r ------------------- ------------- -----------------------------=----------- ------------------------------------------- i ---------------- -------------- ------------------------------------------- ----------------- - ------------------- -------------------------- -------------------- (Draw existin and required additi on reverse side) , I hereby certify that I have prepared this application a work will be done in accordance with Son 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: f "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 Compen3ation laws of California." Signed ------------------ --------------t"'. ------ �A -------------- Owner ��_� f !�`' '- ------------------------------- I---------------- (if ---- Title f. (If ser than own r) ! FOR DEPARTMENT USE ONLY e® � APPLICATION ACCEPTED BY -- --- t--------------------------------------------------------- DATE ---Z-J�f- �, -------F=--- BUILDING PERMIT ISSUED ------- ------------- - ------------------ ----------------- ----------- ` ------- ------------------- --DATE ------------------------------------------- - ADDITIONALCOMMENTS ------------------------------------------------------------------------------------------------------------------------------------------------ -------t_--- ------------ - ------------------------------------------------------------------------------------------------------- - -------------------------------------------------------- - ----------------------------------------------------------------I_ ----------------------------------------------------------------- ------------------------------ ------ ---------------------------------------------------------------------------------------- ----------------- -- Final Ins ection b --------------Date _2_`�_ J ------ ------------------- SAN -- -- ------- 5AN JOAQUIN LOCAL HEALTH DISTRICT �y F H a 1_'AA Rpv SM