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Lr [ FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -7 5/-37 S� fD i3 Permit No. _.................. (Complete in Triplicate) • ......... ......:..........................:• - bate issued ... -'�- 7y sThis Permit Expires 1 Year From 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 with County Ordinance No. 544 and existing Rules and Regulations. I ...CENSUS TRACT --------- ................ JOB ADDRESS/LOCATION ..... .__�p1 . ------••-- ... �� '7J. ". ..7` .. Owner's Name - Phone .. . Address .... .. City ------ - n -- � Z / ., -� . . nnpp Contractor's Name ....�.. J;'.' .....:....License #os-!7 •� Phone Installation will serve: Residence aApartment House'❑ Commercial ❑Trailer Court'-'n I Motel ❑Other ............ --_------------------ F -_------- - -----Garba ��e� ._... Number of bed Number of living units:.. . rooms Garbage Grinder -_- Lot Size _ 111111-Water Supply: Public System and name ---._------------------ r�"�7, Private ❑ .......--... Character of soil to'a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat,❑ Sandy Loam ❑ Clay Loom ❑ 1. Hardpan ❑ Adobe Fill Material ..... -....If yes,type ............................ buildings, etc etc. must be placed on reverse side.) {plot plan, showing size of lot, location of system in relation to wells, NEW INSTALLATION (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ } SEPTIC TANK } Size..:--------•-------------- .......•-......... Liquid Depth ....._............... f Capacity .. .. .. .... -- Type .. .................. Material... --.....:...._.. -- No. Compartments .......... Distance to nearest. Well . .... ......-.......---------------Foundation --................-... Prop. Line ..---------------:--• k LEACHING LINE [ ] No. of Lines.- ---- - -.- Length of each line ........................... Total Length*. ................... I. 'D' Box .- Type Filter Material ------------_-----Depth Filter Material ---- --------------------------------------- Distance to nearest: Well ...-•--------------- --- Foundation Property line ---------...----........ SEEPAGE PIT Depth Diameter _.--------------- Number - -............ ............ Rock Filled Yes ❑ No ❑ Water Table Depth ..----.Rock Size -------------------- Distafice to nearest: Well -.--_-----------.......................Foundation ...--........------- Prop. Line ........_._.....-..... Date ..... 1 REPAIR/ADDITION(Prev. Sanitation Permit# _'L............ .. ------ l - Septic Tank (Specify Requirements) ..4 ,0- �i ....�.....` .3 /�p ---- -- ...................... .,._.. /f ... ' Disposal Field (Specify Requirementsi ... ..•-- 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, Slate Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or iicen- 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." iSigned . ...---- --------- ---- ---------- ------- ••-............ Owner By :� 4. . .-. - - •--- ------ ._..-----• . ...- .. 'Title �.. ... .. ... .... (If other than a ed DEPARTMENT USE ONLY _ _.. _ :dl DATE . ... . "" ._ BUILDING PERMIT ISSUED APPLICATION ACCEPTED BY RATE ................... DITIONALCOMME S .-..... _ - -- - -- --------------------- ------------------ •-:.:_......._.........---...-----•... ..........--.... � : : L�J -- -- ---- :::::::::::::: .-- - -----:-.-: _. ..... .........•-------•---- .-----... ::::::•----::_:_-_•..-:::-_.... -------- ...---.............. .......... to ..... ------Date ..,.. . -- - -.. Final Inspection b . ----- - ----- ------------------------------------------------..._._ 7 S JOA N LOCAL HEALTH DISTRICT 7172 3.X 1.3 24 ;