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FOR OFFICE USE: `APPLICATION FOR SANITATION PERMIT Permit Na. (Complete in Triplicate) _7- ._.._. :---------------------------------------------- D e --------------------------------------------------------• This Permit Expires i Year From Date Issued �D Application is hereby made to the San Joaquin Locar Health District for a permit t it1�- inst I the work herein described. This application is made in compliance 'th County Ordinance No. 549 an existing Rules and Regulations: JOB ADDRESS/LOCATION ._.Ofd--/1_-.--�-- ------ -- - I----. ..- -'---------._ CENSUS TRACT .....................•.... Owner's Name ----- /��- Phone .................................... Address --- --------- - --- --f ---"�-----�- •. -- -------------City --- ----- -- `- ------------------------••-----•------•------•-------- Contractor's Name -------- _ ....... . . - - -�: 41_icense #ldf.31z�Phone ------------------------------ Installation will serve: Residence ❑Ap rtment House 0 Commercial OTrailer Court ,❑ Motel ❑Other...... ... .......... Number of living units:r-_ Number of bedrooms _.ar�...Garbage Grinder _.!T� Lot Size _________________________________•------..._ Water Supply: Public System and name ................... - - -_- -- . ......................... ------Private ❑ Character of soil to a depth of 3 feet: Sand[j Silt❑ Clay ❑ Peat❑ Sandy. Loam Clay Loam Hardpan ❑ 'Adobe 0 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 see ge pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK Size.-•�.� y�.` . ..-� t'z'.___. Liquid Depth ��._....._._ f ,X...... X. _ . Capacity .11P__0_P__ Type Material No. Compartments ............. � Distance to nearest: Well ------ ..................Foundation ------1._Q---------- Prop. Line ___- ............ LEACHING LINE [ No. of Lines --- ------- Length of each line--j------6A.-Il------- Total Length _____ _ ___i____________ 'D' Box Type f=ilter Material ....45-....I'�. ..r...Depth Filter Material ._��l......................7........... Z�s Distance to nearest: Well -----hQ_a__t...... f=oundation -------{_l:?.........__ Property Line ................. [� Depth -----f--P-....__.__. Deameter4,'T_X.. Number ..........I.............., Rock Filled Yes No 0 Water Table Depth ------------------(1/tv t ------ ...........Rock Size ........... Distance to nearest: Well ---------- _1?.....................Foundation ----.1•_Q.._I....... Prop. Line ....5...------------ REPAIR/ADDITION(Prev- Sanitation Permit# -------------------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) ---------------------------•---------•- -------_--_- ----•--•-•••--•--•..................---------i-------- Disposal Field (Specify Requirements) ...........-........................... •-------------•---••------.-----.----•---.------.------•--•--•-------------•.._.._.........-- ---------------------------------------------------------------•--•--••-------••-••----•------------••---------------_.....................I......................_...-•------=------------------------ ----------------------------------- -----------------------•----------------•--••-•-•--••------•--•--------------•--...._........................... --------------------------------------------- (Draw existing and required addition on reverse side) I hereby certify that 1 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 Son 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 shall not employ any person in such manner as to become,sublect to Wor n's Compensation laws of California." Signed . ._ ._..................... .... ---_-------------------•---- --- ............... Owner By ........................... Title ---•-- --------..._.._-..._-.._..------- ------------ jIf other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .. ___..._._-. DATE ........... BUILDING PERMIT ISSUED ...................................... - ---------------------------------=----------.---DATE ------------------------------------------- - --------•--•----- ADDITIONALCOMMENTS --------------• - ------------------------------------------------------------------ -----------•- -------------------- ------------------- --- ------ F ---- inal Inspection by: .- -------- • --------------------------- • -----------------•----------------------•--- Date :j. .� SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M