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---------------FOR- --OFFIC- E_ IJSE:� } _ y APPLICATION FOR SANITATION PERMIT ---- - ---- ------------- -- -------------- (Complete in Triplicate) Permit No.7L: ------- -_-- This Permit Expires 1 Year From Date Issued . F�- pate Issued 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: .1 JOB ADDRESS/LOCATION __-_ p---L�----a--------s------ --- ---------------- --CENSUS TRACT ----- n Owner's Name .-------- -- -----Phone Address ---------- ---- ` _ City �a �` ' r1 ---- Contractor's Name ___. --------------License # �? .c 5 f 6 Phone Installation will serve: Residence oApartment House❑ Commercial : Trailer Court ;❑ Motel ❑Other Number of living units-------!-__ Number of bedrooms -_, -,- Gba - I -_ ar -9a Grinder --_-1�---: Lot Size _�� ---------------- Water Supply: Public System and name --------- ----------------------------•----------- --•------------------ Private Character of soil to a depth of 3 feet: Sand� Silt.❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ �i-Hardpan 1]- Adobe ❑ TFilI Material -A Z_If es;-t f (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' - � Q Size /r--{�---- Liquid Depth Capacity +1 © TYPe -4;1ew k__"aterial -�.P � No. Compartments - P � Distance to nearest: Well -__- _/Od -----------Foundation --- -------- Prop. Line -- __- --_---_. LEACHING LIN _ T; [ No, of Cines -fl --"--____--_ Length of each line----__--7,-__r _-- Total Length --- ---_---.___-_ 'D' Box -_ �`� Type Filter Material __4/_.44e—Depth Filter Material _ (a _ --__-__-"_- 1I . ------- �� Distance to nearest: Well•__ �� laQ i Foundation -" -._ ."---------------- Property Line. SEEPAGE PIT [ ) Depth f--------------- Diameter ---------------- Number .----- - ------------------- Rock Filled Yes '❑ No i❑ i Water Table Depth ------------------------------ ----Rock Size Y'----------------- Distance to nearest: Well ------------------------------ � 1 ----------Foundation''----------- ------ Prop. Line ----------------•---- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -------.------- ••--------------- Septic Tank (Specify Requirements) ---- ---------_---.-_--.___- --------------------------------------------------------- - Disposal Field (Specify Requirements) -------------------------------------------------------- ; I ------=----------------------------------------------------------------- _ -------- --.--_- ---------------------------------------------- t(DFaw existing and required addition-on-reverse side-)--- ----- -' - }_�--��•y 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 that in the performance of the work for which this permit is issued, I4shall not employ aanh p y y person in such manner as to become subject to Workman's"Compensation laws of California." Signed ------------------ - -------------- ---------- Owner r I BY ------------ Title ._ -- ----- -------- ----------------------------- (If other than ow er} " --------------------------- r FOR .DEPARTMENT L15E ONLY , APPLICATION ACCEPTED BY -.-_ a--_ 4r -- QATE - -----�?7-"71------- -------------------------- BUILD ING PERMIT ISSUED ---- --- x ---------------------DATE ------------------------ ADDITIONAL COMMENTS .---- ' - -----------------=--------------- ------------------ ------------------------- --------- - ------------------------- -- ------ ---- - - ------------------------------------------------------------------ Finallnspe - - -. ----- ----------- -------------Date ------- ��_ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M