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FOR OFFICE USE: r APPLICATION -FOR SANITATION PERMIT ---------- -- - -------- Permit No: 7�_ _ {Complete in Triplicate) ----- /V j J�� _____________ _ C , This Permit Expires f Year From Date Issued Date Issued ____.'_____--�Z' f � Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein I described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCA T 2 -��-�---r-=�r--- ---- --- -- -- --------- - 1?�..----------------------- CENSUS TRACT --------------•----------• ' Owner's Name ------ -- Phone Address -------------------- --- --- �`_ -- -=---- ----- J t`€� City -------------------- Contractor's Name ------- --moi `-�--- -.License # dPhone ---------------•--_--•------ Installation will serve: Residence Apartment House-0 Commercial[]Trailer Court Motel ❑Other -------------------------------------------- Number of living units:------ Number of bedrooms .3--___.--Garbage Grinder ____ ------ Lot Size ---<--c------ ._....... Water Supply. Public System and name -------------------------------- ------------------------------------------------------------- ----------------Private Character of soil to a depth of 3 feet: : Sand'[-] Silt E] Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam;❑ Hardpan E_ Adobe Fill Material ------------ If yes, type ------------------ --------- oQ Q« (Plot plan, showing size of lot, location .} of system in relation to wells, buildings, etc. must be placed on reverse side � W NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size-------------------------_---------------------- Liquid Depth _____________ ----------- Capacity ----------- -------- Type -------------------- Material---------------------- No. Compartments ------ --------------- Distance to nearest: Well ____________________________________Foundation ---------------------- Prop. Line .-.._-_-..______._____ LEACHING LINE [ ] No. of Line's ------------------------ Length of each line---------------------------- Total Length -----------.--------._______ 'D' Box ------------ Type Filter Material --------------------Depth Filter Material ---------------.------•--------------------- Distance to nearest: Weil ____________ _________ Foundation __:_---------- -Property TLine ________________________ SEEPAGE PIT [ ] Depth ___________________ Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No I❑ ^� Water Table Depth _----_______ _Rock,SiZe -= - Distance to nearest: Well -----------------------------==-:---------Foul dation -------------------- Prop. Line ----------------_.---. i REPAIR/ADDITION(Prev. Sanitation Permit# ___________________________:_$_______Date ---------------------------------- Septic Tank (Specify Requirements) -- � ------=----------------- ----------=------ - Disposal Field (Specify Requirements)-.,--- -►-=tib v -,_ -� ----- --- - --- -------- - c ,- ---------- - . �� I a -4. �,?� ,-c - - -----------------`---p-------------------------------- ---- '' �� `Z_ _ (Draw isting nd re uired addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's CorRpensation-aaws._Qf California." Signed -------1-------------- ---- -------------- Owner Y ----------------------------------- - - Title ------------- (If other than owner) --------------------------- FOR DEPARTMENT_USE-ONLY. APPLICATION ACCEPTED BY ----t '�-- `� :` - DATE �j, BUILDINGPERMIT ISSUED --------------------------------------!-------------------------------------------------------------------DATE -------------•----------------------------- ADDITIONAL COMMENTS ------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------- ------------------------ ---------------------------------- ------ ----------- --- -------------------------------------------------------------- ------ ------ -- ---- ------------- ------ ------------ ------ -- --1- - -- ------------------- ------y Final Inspection by: .-- ---�- ----- L�i ---•---------------------------------------Date - -7-Z------- r SAN J AQUIN LOCAL HEALTH DISTRICT 7 •7 E, H. 9 1-'b$ Rev. 5M