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FOR OFFICE USE: 7� 'i�, 1 `f 4 . HAPPLICATION FOR SANITATION PERMIT ------------- '------------ (Complete in Triplicate) Permit No. .7��_ -------------------------- ----------------- This Permit Expires I Year From 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 described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCA TI -- t- �j --------- -----------------------------------------CENSUS TRACT ------------- Owner's Name C-2j e a— -- phone ;; -- ---- ----- = "7 LN/ 1 • CitY ---------------------- Address ------ - ---- Contractor's Name _.___ -_. .-� .___.___. _ ._ _. __ ---------------License # --- - _ -a5aPhone _ ._ Installation will serve: Residence partment House❑ Commercial ❑Trailer Court i❑ Motel ❑ Other -------------------------------------------- �y Number of living units:---------- Number of rbe4os ____ ____ Gar age Grind /�.-'''_ Lot Size ._/__ _. 1_- --------------Water Supply: Public System and name ------ _ ----- ___� _____ ________________Private ❑ Characterof soil to a depth of 3 feet: Sandt❑ Clay eat ❑ Sandy Loam E] Clay Loam 0 Hardpan E] Adobe ill Material -1---''-'"--- 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 see age pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ I SEPTIC TANK e_____ ------ Liquid Depth _--- --_'---�-______ {� / q P Capacity __ Type No. Compartments Distance to nearest: Well ___________Foundation _7___p__�_______ Prop. Line -_ _._J-_-,______ LEACHING LINE [ No. of Lines -- Length Beach )ine__ � Total Length _ _ ► �,f ��/ 'D' Box _-- Type Filter Material//Z--------------Depth Filter Material ___ _ __ --_----_----------------.------ , Distance�to nearest: Well .___ ___ Foundation ..../0 Property Line ___________________ SEEPAGE PIT [ Depth �� Diameter �3-- Number --------- _--- ---- Rock Filled Yes No jI Water Table Depth ------ _e--------------------------------Rock Size -_ ---'--------------- f , Distance to nearest: Well _____.__.__-� ______________________Foundation /0-1_._______ Prop. Line s3_ -----__.-______ REPAIR/ADDITION(Prev. Sanitation Permit# ________ ___________________________________ Date ____-___--------.______-__________} Septic Tank (Specify Requirements) -------- ---------------------------------------------------------------- - Disposal Field (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, II shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signe _--- -- -- --- ---- ---------- Owner -------------------------------------------- BY L - Title ----- ---- -- - - ( Chert an owner) FOR DEPARTMENT USE ONLY 7 APPLICATION ACCEPTED BY - ------------------------------------------------ DATE /0 -fit---------,1 BUILDING PERMIT ISSUED ------ ------------------------------ --- ----------------- --DATE ------------------------------------------- ADDITIONAL COMMENTS ___- -- � ------. ------------------------ �- � - -- ------- - - �7" --- Final Inspection b ______Date ____ ___ __ _____ __ SAN J AQUiN LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M