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-FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ---------------------- -- 7 Permit No. 7� (Complete in Triplicate) --•----" ---------_------------------------------ ThisPermit Expires 1 Year From Date Issued Date Issued E�-________-..._-.j 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 .. l.r__ - ._ _ '� ?-- - --/ ----------------------CENSUS TRACT _ �---,•---------- Owner's Name ----- -- 1------- -_ _ ------------ --`--�--------- - -.. ----- -----'- -------------Phone ------------------------- .......... ---- f -------- � - /oj CityAddress .-------•----- � �� Z Contractor's Name ------------------------------------------------------ ----------.License # -------- ------Phone ------------------------------ Installation will serve: Residence ❑ Apartment House,❑ Commercial :❑Trailer ;6b" -41 Motel ❑ Other -------------------------------------------- Number of living units:------- Number of bedrooms __-'------Garbage Grinder ------ Lot Size alt--44',71--— Water Supply: Public System and name ------------------------- ---------.----------------------------------------------------------------Private ] Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam Hardpan [] Adobe X Fill Material ------------ If yes, type ---------------------------- i (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 TANKV Size-1 ?7'+ /X_t -------------- Liquid Depth _ _____________________ Capacity, __ __ _.___ Typef -------- Materia16&74 ."_.____ No. Compartments 2?rn---------------- 11� s Distance to nearest: Well .fid___---------------------------Foundation Jo/_______________ Prop. Line S�r k _________________ LEACHING LINE ;;H No. of Lines _,/__________ ________ Length of each line.___ ------------- Total Length _ r ___-_______._.-_ 'D' Box ------------ Type Filter Material --------------------Depth Filter Material -------------------------------•----.------- } Distance to nearest: Well ___` ''_i __ - --___-- Foundation ---14---------------- Property Line4------------..--._---- SEEPAGE PIT [ ] Depth ------___----------- Diameter _____________ Number ---------------------------- Rock Filled Yes ❑ No Water Table Depth --------------------------------------- --------Rock Size -------------------------------- �E Distance to nearest: Well ____ ___________________________________Foundation -------------------- Prop. Line --_-___---.--------_- REPAIRJADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) --------.-------------------------------------------------------------------------------------------------------- DisposalField (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 San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify a in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to b com subject to W rkm 's Compensation laws of California." Signe ', Owner B - -- ------------- -- ------ ------- ----- ----- -------- Title ------ ---------- ----------------------- ( o dyer t:an owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY :-!/ ----- ^---- '--- DATE ± `--- /---- ---------------- I BUILDING PERMIT ISSUED ---- - &. - .fie ____ .____DATE __._ --------- ______ ADDITIONAL. COMMENTS ,r " ^c ----- ----- -------- - --- --- ----------- ----- ---- ----------- - ------------- - -------- --- 67 Final Inspection by: ._.__! ---------------------r-------------------------------------------- ,, 'G ------------------------- ------------------ ate -------------------- -------------- ,op c;�o z2 --- ------- z2 ,. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 � Rev. 5M