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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7 S"/09 (Complete in Triplicate) Permit No: ..................... ..._'.....................a..................._._. This Permit Expires ] Year From Date Issued Date Issued ._.._......_........ Application is hereby made to the San Joaquin Local Health District for a per 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 .... _ .. � ...., �... .�� _....... � ........:...............0 ...................._..... ENSUS TRACT / Owner's Name , G`'.�> ............... '. ...... ..... (�. .. ................Phone .Q• s Addressrl�._._.. .j �.. � ��_� .. €............. ............. City --------•--•...................••--•----•-----.......... e r Contractor's Name --------_-! ZvX.�-.�_......�, -L'-............'t.License # ; ... PhoneS-V.2" Installation will serve: Residence Apartment House D'Co rnme'rcial:[ Trailer Court 0 Motel E]Other ............ ..... . ................... Number of living units:__.!......- Number of bedrooms ... ....Garbage Grinder lVV__ Lot Size 7,,�. �.. ..•• - f _ Water Supply: Public System and name .................:.................------------------._.................................................._....Private ❑ Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam fl Clay Loam ❑ l Hardpan ❑ Adobek Fill Material ......... If yes,type ...................... .. (Plot plan, showing size of Jot, location of. system in relation-to�'welis, 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 ( ] SEPTIC TAMC [ ] P Size.................................................. Liquid Depth .................... a Capacity .............. Type .................... Material....................... No. Compartments :....................,5' Distance to nearest: Well' ...Foundation .... Prop. Line LEACHING LINE ( ] No. of Lines ........................ Length of each line------_-_----------------- Total Length ....--:--- ------ D' Box Type Filter Material :.:`..: ": " D'epth Filter Material".'":.�: Distance to nearest: Well ......................... Foundation ...... Property Line SEEPAGE PIT [ i Depth Diameter ................ Number ....__---. ............... Rock-Filled Yes ❑ No (3 Water Table Depth ....Rock Size `' 7 --------------•-•- - �, , v Distance to nearest: Well ..:.................. Foundation+.:._.:.-------_----- Prop. Line ...................... REPAIR ADDITION Prev. Sanitation'Permit# .. -------- Date ............. ............1..... ) Septic Tank (Specify Requirements) ............ ......--.�� ,/ G X.2-- ------•-- Disposal Field (Specify Requirements) .........-............................................................................................................................. . .......................................•••-..._.._.._.._.._._..---.................._.._...-----••-----------•--•-...........---------------------------------•----•--•-•--........_._..--------•-------- (Draw existing and required addition on reverse side) 1 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. Horne owner or liven- 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 --------------------- -- Owner --------------- By ................... . ...,......... ........_....... title _. ' �7 z...................... {If other tha peri R ` FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .. _ .. .. ... ........... .. ..QII . ._46-_!'`. ... __.... ....................... DATE BUILDING PERMIT ISSUED ...............•�---=----..........................•..............DATE ..........•.........•...................... ADDITIONALCOMMENTS .......................................................----........------..................................•.._....................I-----............---- ..,....................•--...................._..................._...................................--- -•-..........................---....._._...._........... ............. •---- Final Inspection by: _....... ........ ..... :... ,---------------...._........Date .._�=-•- � -------�`------- SAN JOAQUIN LOCAL` HEALTH DISTRICT/ 1 1-'68 E. H.13 24 Rev. 6M 7/72 3 M