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FOR OFFICE USE !,�s' APPLICATION FOR SANITATION PERMIT -------=------------- 11 Permit No. _7 ---------------.- ---------- ----------- (Complefie in Triplicate) bate Issued __�_,!_-.�0 ------- --41-0 -----_ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin L cal Health District for a permit to construct and install the work herein described. This application is made in compli cy3, h QO t Ord,nc No. 549 and existing Rules and,Regulations. .7YC +0q SUS TRACT __.-•--z7-_6---•-------- JOB' ADDRESS/LOCATION . ------ -�� - �,0 -----°--- Owner's Name --- Phone -- _Cit -'--- --- Address - -------------- Y ,Ag* -------------------------------------------------------- Contractor's Name _-_ -----------------------------License # `- Phone Installation will serve: Residence ❑Apartment House❑ Commercial Prailee Court i❑ Motel ❑Other -------------------------------------------- Number of living units:_____ Number of bedrooms __'" __.__Garbage Grinder &P-- Lot Size ---------- Water Supply: Public System and name -------------------------•------- -----------------------------------------------------------------------------Private 9 Character of soil to a depth of 3 feet: Sand'E] Silt❑ Clay ❑ Peat❑ Sandy Loam ,E] Cloy Loam El Hardpan ❑ Adobe ill Material ____________ If yes,type ___________________________ (Pl'ot 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 I ] SEPTIC TANK [H1000, Size_- f _ '. ►__-�_______________ Liquid Depth ��--____-_-•-______ , ��___ Type off _ Material f:_`__ No. Compartments ____ ------- Capacity _._- Q ' Distance to nearest: Well ___- P-------------------Foundation -_---____..- Prop. Line __rr!7 -- LEACHING LINE [e No. of Lines ---/------------------ Length of each line _`___...____ Total Length��_______-___. 'D' Box/VP_ Type Filter Materia � _Depth Filter Material Distance to nearest: Well 1..�_- Foundation ele--------------- Property Line. _----- ---------- SEEPAGE PIT [ Depth _ _r-___ Diameter -- Number ___. . Rock Pilled Yes No .i[] Ire 14 Water Table Depth ---- eyC__._1------------------------...Rock Size 1_�'-- _JV ____........_._ 01 Distance to nearest: Well ----- Foundation --------•____ Prop. Line ...... REPAIR/ADDITION(Prev. Sanitation Permit# --------------------------------------------- bate ----------------------------------) SepticTank (Specify Requirements) ---- ----------------------------------- --------------- --------------- --------------------------------t.---------------------------- Disposal Field (Specify Requirements) --_------__ ------------------------------------------------------------ ------- ------ ----------------------------- -------------•---------------•--------- -------- 9- - f°'� ,1 � ,� �----Zo -------- (Draw existin and require-d addition on reverse side) lly.p � 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 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 - ---------------------------- TitleBY - - ------------ ) i (If of than owner) Com"'-"". - --- --------------------------------- (if ------------ -------- -------- NT USE ONLY APPLICATION ACCEPTED BY ---- ----- - DATE 'I� BUILDING PERMIT ISSUED ---------- ---- ----------- -------DATE ----------- ----- --------- -- ----------=- -- ADDITIONALCOMMENTS ------------ ----------------- -- ----------------------------------------------------------------- --------------------------- ------------------ - ------- - Final Inspection by: --------�rDate _- ___ ------ SAN . JOAQUIN LOCAL HEALTH DISTRICT E. H."9 1-'6$ Rev. 5M