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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT T Permit No. _-7�-7 �/ (Complete in Triplicate) ` _._-- ------ This Permit Expires 'I Year From Date Issued Date Issued __`T� --_ 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/LOCATIO ------/��-3- ------ C@` f ----: CENSUS TRACT ---g-`-----------•-- - Owner's Name --------------- ---------------------------- --------------------Phone 3 -2—-- Address -/------ - - -•------- - - - -------- --- -----------. City ��' 1�------------------------------------------ Contractor's Name '. I ----- ` `I License Phone i 4 Installation will serve: Residence ,Apartment House❑ Commercial ❑Trailer Court ,❑ w Motel ❑ Other ---------------------------------------- -- Number of living un4s:___/------ Number of bedrooms --- -----Garbage Grinder .---___.--. Lot Size _.__--._____ ) --r---------••----- Water Supply. Public System and name ------------------------------------ Private Character of soil to a depth of 3 feet: Sand'E] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ 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,) PACKAGE TREATMENT ] SEPTIC TANK ize----------✓�! - --------------------- Liquid Depth -----�--_--=----. --- Capacity f - „-- Type __ -- - --►----`- Material_ �G!`1 �- -- No.�Compartments -------------•---••--- Distance to nearest: Well. _-_____----r!5_0_t'_____________Foundation --------- Prop. Line ------ LEACHING LINE No. of Lines --------- Length of each line-------7-5----------"•'Total Length ___�-Z---__:_---._- k 'D' Box ---✓_ Type Filter Material _�E�:T-.K..-___Depth Filter Material _____ _ _____________________.I--__------ � Distance to nearest:-Well -__:----�d__�"�__ Foundation -------/P_`f-------- Propertyline .........- ?� - ------._ Rock Filled Yes ' NoMO f SEEPAGE PIT Depth ___ L_S_______-- Diameter _�_3____---- Number _________________ __ s Water Table Depth ------------------------------ Rock Size Y s .Distance to nearest: Well ___-____f __________.___ Foundation ---58------ __ Prop. Line --- -.--..f'-.....-- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -----------=----------------------- Septic --- -----------------Septic Tank (Specify;Requirements) ------------------- --------------- -------------------------------_------------------ -------- Disposal Field (Specify_.Re`quirements).--------------------------------------------------------------------- ---------- - - ------- --------------------------- --------------- --- -- ---------------------- --'--------------- .-1-- --------------y---------------------- -------------------------------------- - ----- - --_- _ - - (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 pules and Regulations of the San Joaquin Local Health District. Home owner or licen- J. 1 i sed agents signature certifies the following: "I certify that in the performance-of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws, of California." �. . Signed -----=-------------------- ---- - Owner - Title ` -------------------- (!f of than owner) .-. FOR DEPARTMENT USE ONLY k APPLICATION ACCEPTED =6Y ____ : __ _. _ --------------------------------------------- ------------- DATE ' --_ ------71------------- BUILDING PERMIT ISSUED -----------; ' DATE ----------- - ADDITIONAL COMMENTS3_f_KS�._.k-_-_T--`-------------------------------------------------------------------------------------------- -- /'_'` ---------------------------------------------------------------------------- ------------------------ --------7-7.r ------ ------------------------------------------------------------------------------- _ = _= ------.--- - ti- ------------------------- f - - - ---- --- -------------- Final Inspection by: - -------- Date _ t -------- T ;, z SAWJOAQUIN LOCAL HEALTH DISTRICT LL F_ H_ 9 1-'6$ Rev. 5M