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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -- ------- -=-------------------------------- Permit No: ._`7_-3`_G17 (Complete in Triplicate) ----- _----__-.-________________ This Permit Expires Y Year From Date Issued Date Issued ._._____._._______-- 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-,"h County Ordinance No. 549 and existing Rules and Regulations: f . JOB ADDRESS/LOC TI Nom.-- 9 ----------- --- JOB TRACT `S Owner's Name - - - -- ------------- hone -------------------------------•--- Address 1. ----- --- -- ------ - -- --- -- -- - City -----------------------------•---- Contractar's Name _.._.___e �___ (;�V rX r" _— .__.License # _�t�t'".J -Phone _________________________-. Installation will serve- Residence 9APartment House❑ Commercial ❑Trailer Court l❑ Motel ❑Other --------------------------------------------- Number --------------------------- `--------------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❑ Clay ❑ Peat❑ Sandy Loam' Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type --------------------- 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 seepage pit permitted if p blit sewer is available within 200 feet,) /� PACKAGE TREATMENT [ ] SEPTIC TANK Size _�_ _ ____.Y__ ___--. Liquid Depth _q___________________ 1 1!" Capacity XZ420---__-- Type ____---___-_-____ Material--, z` _ No. Compartments _ ........... 09 / Distance to nearest: Well --------Sa'__!_________________Foundation _ Q__------------ Prop. Line ----------------- OQ LEACHING LINE [] No, dunes _-___ ---_- --- Length of each -line----_,,neO-- _-•Total Length ---e-'I_ -------- 'D' Box ._ __/._.__ Type Filter Material -----Depth Filter Material __._/_1�'__'y____________ _____-------- m Distance to nearest: Well -----�� __/_______ Foundation ------f52._--_F______ Property Line ____r-------------- SEEPAGE __---_._--_SEEPAGE PiT [ ] Depth ---- --------------- Diameter ---------------- Number ----------------------------- Rock Filled Yes ❑ No C t (113 Water Table Depth _Rock Size �1` 1 Distance to nearest: Well ___--_______________________________Foundation .------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# _------------------------- A• -------------=--- Date --------------•-------------------) 1 SepticTank (Specify Requirements[ --------------------------------------------------------- --------------------------------------------------------------------------------- Disposal Field {Specify Requirements) -------- --------------------------------------------------------------- -- --------------------- ------------------- --------------- ) ----------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 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 Work 's Compensation law"f California." Signed ------------ --------- - -- --------------- Owner By -------- ---------------------------- - ---- --- ------------------- ------- Title - - - ------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ DATE --- BUILDING PERMIT ISSUED ------------r ------------------------------------------------- ---------------- --------DATE ------------------------------------------- ADDITIONALCOMMENTS ----------- I---------------------------------------------- -------------- --------- ---------------------------------------=--------------------------- -------------------------------------------------------- ------------------------------------------------. --- --------------------------------------------------------------------- ---------------------------------------- - -------- -------------- ------ Final Inspection by: l ----------------------------------------------------- ---- ---- --Date -�. ------- 1 SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.