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FOR OFFICE USE: APPLICATION:FOR SANITATION PERMIT -------------------- =3 d Permit No. -,7/-"� , -Z ------------------ (Complete in Triplicate) I _ - ----------------- This Permit Expires 1 Year Trom Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein scribed. This application is made in compliance with County Ordinance No. 549 and existing Mules and Regulations: a ---- -CENSUS TRACT ------ ------------------- JOB ADDRESS/LOCATION _______�-t'-�+2.._-----�---- - -- ---- ---- ---- --- ----------------------- Owner's Name _ a. _ �� --------------------------------------- -------------------------------------------- -- Phone 1 =��'`� -. Address ---- -----------------i---- - ----------- -----------> -, City ------------------------------------ Contractor's Name _-- -_ : ---_-.License # -- _6_ Mfr Phone -_�"3'14 49 Installation will serve: Residence [A Apartment House[] Commercial ❑Trailer Court 0 r I Motel ❑Other ------------------------------------------- r,�y r ( Garbo �d-_ll__._� s,�---+----- Number of living units:------ ____ Number of bedrooms _ __ ____. ge Grinder _.__.-____-_ Lot Size _____ __ ------ Water Supply: Public System and name ----------- ---- --- -- -------------- -- ------------------------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'[] Silt❑ r Clay E:.] Peat E] Sandy Loam -❑ Clay Loam E]. Hardpan ❑ Adobe Fill Material ------------ If yes, type __________.__._-_-_____ G (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be pldced on reverse side.] 3 NEW INSTALLATION: (No septic tank or seepage pit permitted.if public sewer is available within 200 feet,j [ ] [ ] -" --- --------------------- ------- Liquid Depth------------ --------- ---- -- I PACKAGE TREATMENT Capacity TANK Type S1ZQ al i t No. Compartments Te -------------------- Maters ---------------.._.... �1 jDistance to nearest: Well ------------------------------------Fou-ndation ---------------------- Prop. Line ---------- •---_------ �}1 f LEACHING LINE ( ] No. of Lines ----------------------- Length of each line---------------------------- Total Length ----------------------_._.-. 'D' Box --------- Type Filter Material _-_________________Depth Filter Material --------`_ _______-.____-_.______,__..._... Distance to nearest:-FWell -------f_._____f-----Foundation-------_: --__._-Property Line ------------------------�O r SEEPAGE Depth ---J-.rte__!__ Diameterd�— Number ---- Rock Rock Filled Yes jt�1 No +❑ 1 Water Table Depth .r� c '-{ Rock Size ---------- -. e r Distance to nearest: Well _____ ��_____________________Foundation _._1i_�__Q_-------- Prop. Line ___-e�r____.___.. .. � REPAIR/ADDITION(Prev. Sanitation Permit# ..._-�!.� ---------------------- Date _________�__ _.�� _=__j Septic Tank (Specify Requirements) ---------------------- --------- -----------------------------------------------•----------------------------------------------------•---- If Disposal Field (Specify Requirements] ------- •• -- --- --------------------- ----------- ----- -------------------------- (Draw existing and required addition on reve_i-se side) I hereby certify that P have prepared this application ancl, that the wor0will be done in accordance with San Joaquin County Ordinances, State`Laws, and Rules and Regulations of the San Joaquin Lacal Health Diistrict. Home owner or licen- sed agents signature certifies the following: I "I certify that in the performance of the work for whichthispermit.is issued, I shall not employ any person in such manner as to become subject to.Workman's Compensation laws of.;Califorria'." t Signed ----------- -rt s -------------•Owner 4 ` BY ----- -------------------- ------------ Title - ��- (If other than owner) R DEPARTMENT USE ONLY APPLICATION ACCEPTED:BY `_ = DATE _/I= ' 7� BUILDING PERMIT ISSUED . =k__ a -------------------DATE -------------•----- ------------ - -------- ------ ---- ADDITIONAL COMMENTS --------------___._'______ ` c_ -- ------------------------------------------ ------------ - ----- ----------------------------------------------------------------------------------------------------- -------------- --------- ---------------------- ---------- - -------------------------------------------------------------------------.---------- - ---- Final Inspection by: - Date I. ---- -- ----------- - - --- --- ---- - -------- - -- --- -- --- SAN AQUIN LOCAL HEALTH DISTRICT { E. H. 9 1-'6$ Rev. 5M