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w FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------- ----------------------------------------- Permit-No.---.7 �..` (Complete in Triplicate) _ ��// Date Issued-5 �b-7Q___ ------------------------------ ---------------------- -- This Permit Expires 1 Year From Date Issued 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.--.5".t 6-0 So sl r r�9�-------`�-°3---------- -------------CENSUS TRACT----------- - ---- t Owner's Name----------------Y: _ ._.. Q p��ad[" ---------------Phone--------------------- Address---------------------- - --------- ----------------------------CitY------=---- ------------------------ -Zip--- -------- ----------------- Contractor's Name rl- �-� Tf fir' -----------'-------License #_/E4T, -Phone---�.�3v Yom!-`�---- Instal lation,will serve: Residence Apartment House ❑ Commercial ❑ 'Trailer Court ❑ Motel ❑ Other--- - ------=-------------------- ; I _ t Number of living units-------l--------Number of bedrooms:__% -----Garbage Grinder-__________Lot Size_________________________________________"__-------------- - Water Supply: Public System and name------------------ _. ----- -----------------------------------------------7------------------------- --.--Character of soil to a depth of 3 feet: ` Sand ❑ Silt❑ _Clay ❑ , Peat ❑ Sandy Loam X 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 sewer is available within 200 feet,) - E - PACKAGE TREATMENT [ ] SEPTIC TANK [ ] -: Size-------------------____________"_"-___________�_______----Liquid Depth.---- -------------------- �+ Capacity-- ----------------- Type- ----------:_Material --------•----- ----- '--No. Compartments-----------------------------------r Distance to nearest: Well-- ------------------=------------ ------Foundation-----= --------- -------Prop. Line--------- ----------- r LEACHING LINE' [ ] No. of Lines'--------------------------- Length.af each line-----------------------=------Total Length-------------------------,--.--------- � 'D' Box_-----------Type Filter Material------ ------_.Depth Filter Material------------------------ -------------------------------------- cJ Distance to nearest: Well----------------------------Foundation__--------------------------Property Line------------------------------- SEEPAGE PIT [ ] Depth----=-----------Diameter- -------------------Number---------------------------------- Rock Filled Yes ❑ No ❑ WaterTable Depth-----------------=-------------=------=-----=-------------Rock Size------------ ----------------------------------- I ------Foundation------- -----+_ .. _ Prop. Line-----------------------'- 14,L, W i Distance to nearest: Well---------------------- -------------- - _ .------: REPAIR/ADDITION {Prey. Sanitation Permit#------------------------------------ --------------Date-------------------------=-_-------------------} SepticTank (Specify Requirements)------------------------=-- ----- -----------------------------------I----------------------- ------------------- ----------- ---------------=------------- cd` i 7/0 w a- -------`--E'--------------- ---��r.---------------------- k Disposal Field (Specify Requirements)=--_._____-_9e. , ,-- -------------- ------ amix-.'s-- `i�' �`sT€�`� -- - -------------------------------- ---------------- ------------------------------------------ --------------------------------------------------------------------- --___-_____________________________________________ __ _ _ ___--;----____________-___-_-_-__--___--_______-____---___-- (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 rOrdinances, State Laws, and Rules and Regulations of the .San Joaquin Local Health District. Home owner or licensed 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 a to become subject to Workman's Compensation laws of California." f__ . . . - .F Signed _ '�-Sv- _Ow ner- B Title ----- -- I (If otheowner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTBY---- -- -- - ----- - - -------- _0 = ---- -DATE.--- -+ ---- --------- DIVISION OF LAND NUMBER-------- ---- T DATE. ADDITIONAL COMMENTS---------------- - --- -------- -- ---- ------------------ . , ---------------------------•------------------------ _._ ---------------------- -----------r`---- ----- ------------ ----------------------- -•------------ ------ --------------- ------ ---- -- - �„ Final Inspection bY: �• - ----- - ------------- Date EN 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&s 2ian REV. �nb 3nn