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1 FOR.OFFICE USE. APPLICATION FOR SANITATION PERMIT T... ........................................ (Complete in T&llcate) Permit No.,__—..7,5 ......................................... ....... .... .. .... ....... This Permit Expires I Year From Date Issued Date issued :'2 .. #:.� ., Application is hereby made to the San Joaquin Local Health District for a permit 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 ION .._. 6.,5-4-Z_, y___•-� Gc-t :-- . _. �.......... ....................CENSUS TRACT ............... �� ,_" - . -T ...:.........Phone : � -- .Owner's Name _. ..87:1.: ..-..-- -- �lX,n:........_�-------------------------------------�---............:.......... .......---•-----•._................ Address ........... .. City Contractor's Name _7 ... . ... ........ -----------��ent ....---•---••-------------•--....License # ........---•---•-•--=-=- Phone,................_._..._.�.... Installation will serve: Residence House Commercial ❑Trailer Court 0 I Motel ❑Other Number of living units..../------- Number of bedrooms (T-------- Grinder ............ Lot Size ............................................. Water Supply: Public System and name ..........................................................I.,......I................. ......Private,❑. Character of soil to a depth of 3 feet: Sand,❑ Silt❑ Clay ❑ Peat❑ 'So'ndy Loam Clay Loam ❑ Hardpan ❑ Adobe❑ Fill Material ............ If yes,type ----------------------_-.--- (Plot plan, showing size of lot, location ofsystem in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepa pit permitted if public sewer is available within 200 feet,[ PACKAGE TREATMENT [ ] SEPTIC TANK [ Sia . .. .. ___ /�� / C /� -------------------•- - . ..._....... Liquid Depth y�-� ............ Capacity L'-�� Type +� 0` Materials * ... No. Compartments 2 I Distance to nearest: Well ------ -�--------.. ..........Foundation -----------•- Prop. Line ' ........ LEACHING LINE '[ql/ No. of Lines ........ ............. Length-of each line----------- Total Length .....4•6-..)..-•--------- D' Box /4._.:._ Type Filter Material Depth Filter Material ............:1 .................... k Distance to nearest: Well ........... Foundation .!;�(Z_............. � _ Property Line ............. SEEPAGE PIT [ , Depth .../.- --'_____ Diameter L1_.x�1... Number ____._2.................. Rock Filled YesNo ❑ .........................Rock Size • Water Table Depth 'yam r� Distance to nearest: Well .../12�L.t ....Foundation .--/cap..:....... Prop. Line . REPAIR/ADDITION(Prev. Sanitation Permit# ................•. ..." --------- ---- Date ............. Septic Tank (Specify Requirements) - - .....................- ......................_......__..._..... X DisposalField (Specify Regiiirements) ....::....:...•••-•-•.....,._......• ...........------------•-----------..._................................................... ___._'____-----____ __•••-•.-..._______..-------__.___-____•_ --_....•. ..._._._______--_- •_•-_-__--_____-_--- -- -_--______________..__...-------•....._...__.__.___...._............:........._._..._.._.. i .(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 #fie Sari`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 becom"ubject to Wo kman's Co ensation laws of California.", •� d Signed .. . . __. -....... Owner By ----------------------- •---------............._..._:... . ...------...........__... Title ......_._..-_..._..-............._ -------------- (If other than owner) OR DEPARTMENT LISE ONLY APPLICATION ACCEPTED BY .............. .....: . :.. --------...................... .................. DATE .... BUILDING PERMIT ISSUED ...................... :...................... DATE ----._...--•-- • ADDITIONAL COMMENTS .._..... --- ..... ........ .............. ------•--------- ..__............................. .......... -----------•................ ...•--••-----------•----......-- :- -••-------. . ---•........ ....... ... ......_..-- . ..............-----•--...---------------....-----------------•--•- ------------------•------------ "-----.....----•-•• ---- ................ ..................... Final Inspection by ,? �'�./. .................... .....'. ........ ..............................Date .. . .... 1.�2 .........._._..... —SAN JOAQUIN LOCAI.-HEALTH DISTRICT-