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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------------------------- ---------------------- Permit No. 7-/S ------------------------------- (Complete in Triplicate) ' = - p �L Date Issued .____. .__. This Permit�Ex fres ii Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations..r JOB ADDRESS/LOCATI N _ ---- -------------CENSUS TRACT .-5 J --------- -------- -----Owner's Name --- Phone ------ -------- Address �� f ---------cc �� ` City = = Contractor's NameLicense # __« 8y_ Phone ------------------------------ Installation will serve: Residence [Apartment House❑ Commercial :❑Trailer Court ;❑ l Motel ❑ Other -------------------------------------------- Number of living units ---- Number of bedrooms -------Garbage Grinder ------------ Lot Size --------- Water Supply: Public System and name -------------------- --------------------------------------------------------------------•----------Private Character of soil to a depth of 3 feet: Sand'❑ Silt 0 Clay ❑ Peat❑ Sandy Loam ,0 Clay Loam _—Hardpan E] Adobe ❑ Fill Material ------------ If yes, type ---------------------------- (Plot plan, showi.r g size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (Noetic tank or see age pit permitted if public sewer is available within 200 feet,) _ : PACKAGE TREATMENT [ SEPTIC TANK'[ ,� //��+ Size_Jr_� _gip- -X--ter-—----------- Liquid Depth ____-- ----------------- Capacity _------- ----- FFI� r ] --_ I�C �T e i��-�- -- Material_ _'-L -- No. Compartments _-- .-••-- -- Ca acit � p Y - ------ . - Yp -- � � �- , ,Distance to nearest: Well -------t- _-� ________-___ Prop. Line ______ _---------- LEACHING LINE [ ] No. of Lines ------- ----------- Length of each line---------Z,1�__f---_.__ Total Length '13—' Boz(_ Type Filter Material ----- _ ---Depth Filter Material ---------- -----------------------;---•----• Distance to nearest: Well --------:4��......... Foundation ---------ltl.......... Property Line ___,__S•______________ ter- __--______ y SEEPAGE PIT ameNumber ________ ________________ Rock Filled Yes'❑ No WaterTable Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest:-Well ----------------------------------------Foundation -------------------- Prop. Line _------------------•-• REPAIR/ADDITION(Prev. Sanitation Permit# -------------- ----------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) -------------- -------------- ------------------- --------------- ------------------------------------ -------------- ------_- DisposalField (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------------------- ------------ - - - - - ------------------------------------------------------------------- (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 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." Owner _ � Signed � •-•- • ----------------------------- -- - -------------------------------------- ------------------- ( BY ------ �� "` �------------- elf`-------------------- Title __rte!' ,o c (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------------------------------------`------------------- DATE _.. ~3 r IBUILDING PERMIT ISSUED ---------- ------- --------------------------------------------------------------------------------------DATE --------------------------------------,---- IADDITIONAL COMMENTS ------------------------------------------------------------------------------------------------------ ------------------------------------------------------- ------------------- ----------•---------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- i ----- ---------------------I------ --------------------------------------------------------------------------------------------------------------------------------------- -------1,------- -•----------•- ---------------------------------- ----- - - ---------------------------------------------------------- -----------------'r — Final Inspection by.. ----------------------------------------------- .Bate --r-- SAN JOAQUIN LOCAL HEALTH DISTRICT pi E. H. 9 1-'b8 Rev. 5M ,„