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FOR�OFFICE USE: APPLICATION FOR SANITATION PERMIT �_3_ ,, , Permit No. 7�_._ - -___- ----------- -----------1_,;---------- ---------- ---- (Complete in Triplicate) --------------- Date Issued --�D."-------�- � --------------------------------------- his Permit Expires I Year From Date Issued L lication is hereby made to the San Joa um oc AppAealth District for a permit to construct and install the work herein described. This application as made in compliance with County Ordinance No. 549 and existing Rules and Regulations: ,CENSUS TRACT -------------- --•-------- JOB ADDRESS/LOCATION -- Owner's Name _ r - - one � � --- -------------------------------- -----. City , -------------- ----------------------- ------ 4_i Address ------- a�ffi Contractor's Name --- � License #1 � 9�_ Phan ,j t Installation will serve: Residence��Apart eXf,House❑ Commercial:❑Trailer Court i❑ Motel ❑Other ---� --------------------------------- ,p V ] ' Number of living units:---/----- Number of bedrooms �`'-"--_Garbage Grinder -- -- 'Lot Size -_-- Water Supply: Public System and name--------------------------------------- 1__ ___ --_-------- ------- ---------•------ Private, ( Character Pof soil to a depth of 3 feet: Sand'El Silt❑ Clay' ❑ Peat❑ Sandy Loam ❑ Clay Loam i Hardpan ❑dobe ❑ FII Material ____-_ ..- If yes, type ------------------------ Mf s (Plot plan, showing size of lot, iocation,-of system in relation to wells, buildings, etc. must be placed on reverse side.) `R Nq NEW INSTALLATION: (No septic tank or seepage. pit permitted if public sewer is av ilable within 2d0 feet,} PACKAGE TREATMENT,,,[ ]IF 'SEP'TI'C TANK[ l Size------------------------I---------- ---- ---- Liquid Depth --------------------------- C --------------------.----- Caa' . Type ----- -------------- Material---------------------- No. Compartments ------ -------•------- pcitY Distance to nearest: Well ------------------------------------Foundation -----.---------------- Prop. Line ---.-----------.------ ' Length of each line------------------------ 'D' ------------------ --- ---- Total Length ----------------------•--- LEACHING LINE [ ] No. of Lines ------_ ------_---_ _- D' Box ____----_ ylpe Filter Material --------------------Depth Filter Material T --------------------•---------- �. .. .. . Distance to nearest: Well ------------------------ Foundation -___-------------------- Property Line, ---_-...----.- 'ISEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number .--------------------------- Rock Filled Yes ❑ No ❑ fi Water Table Depth - ---•---Roc Size -------------------------------- A ------- ------------- -------- ---------------- l f II Distance to nearest: Well ---------------------------• A ---Foundation -------------------- Prop. Line --------------------•- ,REPAIRJADDITION(Prev. Sanitation Permit,# ------_------------- --------------------- --------------------- --------------� - Date -------------------------•- ) Septic Tank (Specify Requirements) ----------------------- -------- --------------_-------------- c sem' --- _ ,M Disposal Field Specify Requirements) -- ��---� --------� - ---'�� ------ - - .� // �d I ----------------------- 6 (Draw existing and required addition on reverse side) "1 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: J "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 la s of California." Signed -------------------------------- --- ----------------- - --- -- -- ----- ------------------ Owner Tit ----------------------- ;By (If other t owner) 1 /f 7 P ENT IJSE ONLY !JAPPLICATION ACCEPTED BY _.------ DATE -./--P--7--6-_-?-�----•--------- -- ----- -------- - ' '':-BUILDING PERMIT ISSUED - ------------- -------- ! - --------------- -------------DATE ------------------------------------------- `' ADDITIONAL COMME 1�- ----- ------------- --- -----�----------- -------------- --------------- ------ --------------- - T-- --------- Og 0--Cir`--------)-3.......... r �� Y� X / - �� ------- t -- ---- --- - -------------------------------------------- ------ :i Final Inspection by: ___-- -----------------------------Date ---f .�'- �°" SA JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M '' '' ` __