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OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. 7:FOR ---------------------------------- -- (Complete in Triplicate) p r Date issued This Permit Ex ires i Year From Date Issued Application is hereby made to the San Joaquin Local Health bistrict 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: 44 ----------------- ----- ------ CENSUS TRACT -------------------------- JOB ADDRESS/LO ON �� } nPhone ------------------------------------ Owner's Name -__- -- �' � --- -- -- - --- ---- - � _ ._.. Cit - --- - ��------ --•---------------- ---------- --------------- Address ---------I ------ ---- -------- y r _ Phone Contractor's Name ___- .__ 4u --- ----- ---- - - -------- - �k�•� --.License # g-. ---- -- lnstallation will serve: Residence Apartment House❑ Commercial ❑Trailer Court 0 Motel ❑Other-------------- --------------------------- ` ___--��-�--- --------------- - Number of living units:----- -- Number of bedrooms"__- -----Garbage Grinder ------------ Lot Size s Private ' `a: � -Peat r Sand Loam - ---------------- ------------- Public System and name ----------------------------------- - ---- - -- _ _ _ _ - 1 ❑ Clay Loam ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ ❑ l y` e ---------------------------- Hardpan Adobe ❑ Fill Material ____--_.____ !f es, type bu�tding ;etc. must be placed on reverse side.) (Pl'ot plan, showing size of lot, location of system in rela#ion#to�welts, � NEW INSTALLATION: (No septic tank or seepage pit permitted,if public sewer is available within 200 feet,) e' E PACKAGE TREATMENT [ I SEPTI TANK Siz ____ _� ____: ----��---;r--------- Liquid Depth _- --�/]• `Y� '_ Type lcl'c�'___,Material__ r- No. Compartments ' D Capacity i Pr c eto near t: Weli ------------riV_ ---------Foundation ------- No. ----- g Prop. Line r3 ` LEACHING LINE [ No. of Lines _.__ ;---_--_____ Length of each line-------- - --�---- -- Total Length -� ' ad 'D' Box __ ----- Type Filter Material ------!$J7,,_,Depth Filter Material -__- -- -_ ----------------------•-- ---- ` L�_f-_____ Foundation .' -- ------------ Property. Line ---S_f�- ----------- Distance to nearest: Well ------- - { ` tDiameter --- Number,....------ -SEEPAGE -- .y �----- -Rock Filled Yes � No i❑ PIT { Depth _��- ----- �.. i 1 __..Rock Size -r - X Water Table Depth ----------�------- ,; i p 4 op l f Foundation _ -------- Prop. Line ..._�------------ -' Distance to nearest: Well ____------ --=---- `� ! REPAIRfADDiTION(Prev, Sanitation Permit# -------------- ---------- s. Date 1 "-Septic Tank (Specify Requirements) --------------------- -- --------------------------------------------17__.____ Disposal Field (Specify Requirements) ------------ ---------------------------------------------------------------------------------------------------------------------------- s ______________.__-_________--_________---__ ---------------------------------------------------------------------------- p � � k (Draw existing and required addition on reverse side) I hereby certify that I have prepared this a plication 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- 4 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 ----- ----- ---------------- - Title ---PI-A-11, I&------------ ----------------------- By { (If other than owner) FOR DEPARTMENT USE ONLY ' - DATE _ - ----------------- APPLICATION ACCEPTED BY --- _ BUILDING PERMIT ISSUED ------------------------ ---------------------------------------------------- • - ------DATE - --------- ---------------- ------------- --------- - ------ ADDITIONAL COMMENTS -------------------------- - ---------------------------------------------- ----------6- ate ------------------------- - - Final Inspection by: ----------- ------- -- - SAN JOAQUIN LOCAL HEALTH DISTRICT C u a 1-'An Rpv- 5M