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FOR OFFICE ' APPLICATION FOR SANITATION PERMIT fe ............. ................... ..... Permit No. _7X7-;U- ,.c X-=�.c (Complete in Triplicate) -------------------------------•---------._._........----- .�.1.7..,7.� --------------------------------------------------------- This Permit Expires i 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 incompliancewith Co my Ordinance No. 549 and existing Rules and Regulations; JOB ADDRESS/LOCATI Of - � �' � ` - --- - - --•---- • -.__ .. CENSUS TRACT ..'�...y�.....-•----- a0� t3Z2-.,p2 Owner's Name ---- �-- - - . _.. .. .. ----_---------------..................•-•-- - -- Phone ........ Address _. ._..... . ................. . .......City ------- Contractor's Name --------A.... !�.r �6- -3r ..License # Phane .............................. Installation will serve: Residence Apartment House Commercial ❑Trailer Court Mote! ❑Other--- ---- --- -- - - ------------------ Number of living units:----- ------ Number of bedrooms . _.Garbage Grinder ............ Lot Size ............................................ Water Supply: Public System and name ....................._........................................................................................Private I Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam❑ Clay Loam Hardpan ❑ Adobe-E] 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.) 1•• NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK t ] Size..................----------------------------.. Liquid Depth ------................... J�, Capacity .................... Type -------------------- Material-------------.-.------ No. Compartments Distance to nearest: Well ____________________________________Foundation ---------------------- Prop. Line---------------------- LEACHING _..-_.-..__-.__-_._LEACHING LINE [ ] No. of Lines ........................ Length of each line..............-------------- Total Length ............................ i 'D' Box ............ Type Filter Material ---------_----------Depth Filter Material _______ .................. Distance to nearest: Well ........................ Foundation Property Line ........................ r SEEPAGE PIT [ ] Depth Diameter _______________ Number ---------------------------- Rock Filled Yes ❑ No ❑ s Water Table Depth .•.................................•••-•--------Rock Size -----------------------------•-- Distance to nearest: Well ........................................Foundation :,_,,------- ........ Prop. Line _.._------__________-_ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) SepticTank (Specify Requirements) ................ ......-----------------------------------------..............................................._..------------•------------ Disposal Field (Specify Requirements] ----- .. _-_ .crrr .. .......... .....• , -- ------. .------ _• ---- ---------------------------------- Vin" ----•--...e•._...------._....._Vi`" _.. ...... ........ -•-----•-------•------------------------------------••-------- ------------•----------------.. �....... ........ . `9`----- ;----- ------ - f- [Draw existing and required d-iti on erse side) I hereby terrify 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, I shah not employ any person In such manner as to become subject to Workman's Compensation laws of California." Signed ............ .............. -----------•-------- Owner BY ----- itle � (if other than owner) ` FOR DEPAitTMENT-USE ONLY OF APPLICATION ACCEPTED BY .. ----... . .. DATE BUILDING PERMIT ISSUED ........................................................... ........ ...........---....................DATE ------......................_.............. ADDITIONALCOMMENTS ------------•............._-..---------------------•-----•-•--------------------•---.-._-.---------------••------- ----------------------- .................... -•-•-- ---------._..-.-.._._..-------------------.---.-..--••--•--•--••-•-•-------...._....................---•--------.._._._......_..._. ----- ------------------------- -........-- Final Inspection by: _-- _ - Date .... -• ... SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6B Rev. 5M