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- FOR OFFICE USE: =. li zz171/ 1 APPLICATlONflR SANITATION PERMIT --- Permit Na. _7� ---------------- (Complete in Triplicate) _- /� __. ----------- ----------------------------- ------------------------------- --- This Permit Expires f 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 with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ---- --------- --- ----- - ----- -------�l---y-.' ' --- -----CENSUS TRACT --------------__-------- --- Owner's Name ___Phone - zXr--___ Address ---- ----- ---------).,�95/ ------T --•--- City ------------------- ------•-- f Contractor's Name ------------ ----- - �-1. � License #�( / Phone 7_� --^-7E�Q 7 Installation will serve: Residence ❑ Apartment House❑ Commercial :❑Trailer Court ;❑ Motel ❑Other __-yds -e-_ � Number of living units:------ Number of bedrooms ___:�arbage-Grin.der ___ Lot Size '_----------��T�--------------- Water Supply: Public System and name -------------------------------------------------------------r-Ze -----------------Private ❑ Character of soil to a depth of 3 feet: Sand b Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam :❑ Hardpan ❑ AdobeX Fill Material ----- 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: J 1septic tank or seepage pit permuted iLpublic sewer is available within.200 feet,) PACKAGE TREATMENT SEPTIC TANK, je____-57" _--_-__)__________________ Liquid Depth _>� �_______--_-- Ca acit ��-r�_6 f/ T e ------------- , ` No. Com artments ------• •----.P Y - YP ----- Material��`�� p Distance to nearest: Well ------------------------------------Foundation ---/C?------------- Prop. Line _ "....._ LEACHING LINE No. of Lines -------/--------------- Length--ofeachEine.__._/_ _____.` Total Length ---l. __._______.__.. 'D' Box ------------ Type Filter Material -!_ &{__Depth Filter Material --__/S-------------------------------- Distance to nearest: Well ________________________ Foundation ----/O-i.......... Property Line _-_-__-_--__ SEEPAGE PIT Depth __ ______ Diameter' __ _ _______ Number _.....___ ------------- Rock Filled Yes No I❑ Water Table Depth ------------------------------------------------Rock Size I/ 6-------- i Distance to nearest: Well --------'----------------------,---------Foundation ------- Prop. Line ......... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------V------ Date ----------------------------------) SepticTank (Specify Requirements) -------------------------- -------------------------------------------------- --------------------------------- --------------------------- Disposal Field {Specify Requirements) ------------- -'---------------------1-I------------------------------ ----------------------------------------------------------- ---------------------------- 1 =, a : --------------- --- ------------------------- - ----------I------ ------------------------------------------------------------------------------- ---- (Draw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will be none 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 Workman's Compensation laws of California." Signed ----------- ;fir - =:4------------------------------ Owner s �/ --i1-------- --------- - - - -----=:-- ------------------------------------- Title BY --------------------- ----------------------- {If er than owner) OR EPA' NT USE 014LY APPLICATION ACCEPTED ----- -- -- ----- ---------------------- DATE --- ,7v BUILDING PERMIT ISSUED -- --------------------------- r DATES ------ --------- ------ ADDITIONALCOMMENTS - ---------------------------------------------------------- ------------------------------------------------ --------------------------- ------------------------------------- --------- ---- -- --------------- -------- ------------ ------------------------------------------------------------------------------------------------------------ -------------------_--—---------- -- ----- ----- ------ ---- ----- ----------- --- -------------------------------------- Final Inspection by: -- ----- -------.Date --- C. ___�_'Z _ -Z---------- SAN JOAQUIN L C L HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M