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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ............ 1—............ (C�n Triplicate) Permit No.7 S`.��/ ... .. This Permit Expires I Year From Date Issued Date Issued n�.:.7 Application is hereby made to the Son 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 3�3 } ,Sa: i Regulations- ....... CENSUS TRACT / /f D Owner's Name ... -- ----------------- ........ Address SD. s.-. P. .... . ...................................I City 5T.QCK.T,P.!J.. �r9 4..._......... -•--• �. . Contractor's Name ------------------------------------------------------------- ..........................License i# .......•-............... Phone ................ ............. Installation will serve: Residence N Apartment House❑ Commercial ❑Trailer Court Motel ❑Other...........................I............. --- Number of living units:...../.... Number of bedrooms ......Garbage Grinder .*�% Lot Size .......: 7/74,- S..... Water Supply: Public System and name -•---------•---- •..........................•--...-•=--.._......._._.......-.......•--..............._........Private Character of soil to a depth of 3 feet: Sand❑ Slit Clay ❑ Peat❑- Sandy Loam §ff Clay Loam ❑ Hardpan ❑ Adobe'(] 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 sewyr Is available within 200 feet,¢ PACKAGE TREATMENT X 5� f9 SEPTIC TANK ] Size_-•--....-•----• --•- --•--.�..5...... Liquid Depth ....... ...---•--- Capacity -1x00 A[S Type e4 Cr aterial...................... No. Compartments Distance to nearest: Well --------l A.a.................Foundation ..3q...11 ..... Prop, Line O,(ic.2 LEACHING LINE DQ No. of Lines -_ .,. -------• ------------ Length of each linp...��D................ Total Length .•..�rP4..__...... s- 'D' Box ..---i� � Type Filter Material /?05 � viepth Filter Material .......-./7........ Distance to nearest: Well ..... ----- Foundation ------��.�.---... Property Line .............. . SEEPAGE PIT O Depth -------------------- Diameter .......... Number ------- Rock Filled Yes ❑ No ❑ Water Table Depth ----------------------- ------ ------ --•--.....Rock Size --------------••.... ........... b` Distance to nearest: Well ........................................Foundation ...........-........ Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# -.------------------------------------------ Date --------------.......------------ .) SepticTank (Specify Requirements) ................ --.----•-- ...... ......................................................................................................... Disposal Field {Specify Requirements) --•........----------------------------------...------------------.....------------------------•--------------------- -------------•-•-------...------------------------------------ ------ ----------------.....-----------------------------------...........................--------------•........................ --•------------------- ----------------------..............................................-------•---......----......................... (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 Son Joaquin Local Health,District. Home owner or Ilcen. 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 tp Wo km 's mpensation laws of California." Signed --------------------- ------ Owner By ---- ------------------•---- -..----- --- ----- Title (If other than owner) r EPAIRTMENT USE ONLY APPLICATION ACCEPTED BY - -- - ........ - 's BUILDING PERMIT ISSUED � - � DATE r ADDITIONAL CQMMENTS ......... .. ......... ................ ----.---- -------DATE -----------•---•---------- --•------ -- ---•---- - - ...-----•-•-----••-•-..-- - •--•----- -----•---- ........------;!Z...........1-1------ - - --- - --------- ..-- • ---------- - ---- -•------------------- -------------••----- ----------------------- -----------....- ------- - -----------• --••- ----------•........ ................................ . Final Inspection by- ------------------------------------------------------------ -•----•----•--•--------•-- y. ...Date .ra_7 7 13 21; 1--6$ Rev. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7It 3M