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FOR OFFICE USE: APPLICATION ICOR SANITATION PERMIT Permit No. 7-Sr"S�3 ..........I............................•......... (Complete in Triplicate) .................. .............................................. This Permit Expires 1 Year Front.Date Issued Date Issued 7:� ........... 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 ..._.. � .......5 .,.., �F ,�1.......��..._ ---•----•-••--- ��yy' �-• -- -_•...............CENSUS TRACT ..:......._ Owner's Name Sf- .... 1 /} � f. ....................................................................Phone Address .......... .---------•-_-----_... ..........................•......_..._. City . j /7�..Gf �S f ................. Contractor's Name . .� '� �� K�..S .License # 122.8W. Phone Installation.will serve: Residence(R Apartment House C) Commercial❑Trailer Court E] units:-../ Number of bedrooms Garbage Grinder /�.__.__. Motel ❑Other....................... .. -------- Number of living uni / .fU .. Lot Size Water Supply: Public System and name .. ........:........._.....................----_...............................................Private (3�` Character of soil to a depth of 3 feet: Sand 14 Silt❑ Clay ❑ Peat❑ Sandy Loam o Clay Loam o Hardpan❑ Adobe 0 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: (No septic tank:.or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT I ] SEPTIC TANK{ ] Size................................................ Liquid Depth ..._--...___...._.....__.1 Capacity -_. Material...................... No. Compartments ' ---...- . ----=--•- Type •--•------------- ...................... Distance to nearest: Well ....................................Foundation __._....... .......... Prop. Line....................... LEACHING LINE j No. of Lines ------------------------ Length of each line.._---....-----.............. Total Length ............................ 'D' Box .............. Type Filter Material ..........::........Depth .Filter Material -_.......................................... Distance to nearest: Well ........................ Foundation ----------------- Property Line ...............:........ SEEPAGE PIT ( ( Depth .................... Diameter ....__...._._... Number .----...._---..------------- Rock Filled Yes ❑ No 0 WaterTable Depth ..........••....................................Rock Size ................................ Distance to nearest: Well ........................................foundation ._.......... ....... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit#---_--_-- -------------------------------- Date .................................. Septic Tank (Specify Requirements) ................ Disposal Field (Specify Requirements) -------------------------, ------------ �......•-- ._/ .---,,�,�f1�;�`'._............ ,.. -------- /1..----------- S --------------------- ------------------------- ...........................--- ----- --------------------.......---•--•--...._._..---•••-••----_- -------- ....... .......*............... (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 Workman's Compensation laws of California.- Signed alifornia.Signed ---------------------------- 01----------------------- ---------------- _ _...----- -----. Owner BY -- -- - -- ------- -------- Title - . ----------•- - (if other than owne - -- -- - • •• --�• • • _ DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------_�.c_, - -------•---.•------------•-•---- •---•--- ---------- --------- DATE _�. ..l..7.. ._�- ------ BUILDING PERMIT ISSUED ......................•---=.--•--------.,----•---------....-.....-.DATE . . ADDITIONAL COMMENTS ----------------- ..............-- ....... ........................... •-•----------- - .......... ............. ... --..------ ... ..... Final Inspection by: _.- tr----_- ---------- --- ..................... ------------------------------- -Date -. d _.. ... .._-..... ,EH 13 2� 1-6f3 IZev. f SAN JOAO IN LOCAL HEALTH DISTRICT 8/7h 3M