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FOR OFFICE USE: �f 'PLICATION FOR SANITATION PERS Permit No. .7�.-��.V../ (Complete in Triplicate) This Permit Expires 1 Year From Date Issued Date Issued --- ... .�:-7.� ...................... Application is hereby made to the San Joaquin Local Health Distric for a permit to construct and install the work herein described. This application ismade ipd aanc'D� 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .drr .-/-�w_. .._. �'�' '�CENSUS TRACT ._.5... Owner's Nampj �?Z -a- .`� Y ._..r0.... -. ---------Pone . Address (T.,..O.r_ L .. 7• --- •--. City -------- Contractor's Name „. K` • ------------- !{ ``` -..License #,� ` �� Ph. e ........ ..................... A artment House Commercial Trailer Court Installation will serve: Residence ❑ p ❑ ❑ ❑ Motel ❑Other Number of living units------------- Number of bedrooms ------------Garbage Grinder .-.......... Lot Size -------------------------- ---- ---._.._._...__._ -..---..____ _._ Water Supply: Public System and name --------------------------- ---•-----------•---•---------------------.---.--- Private (� Character of soil to a depth of 3 feet: Sand'[] Silt El Clay E] Peat E] 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 [ ] Size................................................ Liquid Depth .......................... Capacity -------------- ----- Type -------------------- Material.----- ------ No. Compartments ------------•-•-•----- Distance to nearest: Well ....................................Foundation ..- ------------ Prop. Line -.--_---____---___-_-- LEACHING LINE [ ] No. of Lines ------------------------ Length of each line--------.................... Total Length ............................ 'D' Box ------------ Type Filter Material ______________ Depth th Filter Material ............................................ Distance to nearest: Well ------------------------ Foundation ..................------ Property Line ........................ \ SEEPAGE PIT [ ) Depth .................... Diameter ---------------- Number .... ----------------------- Rock Filled Yes ❑ No p 1 Water Table Depth ------------------------------------------------Rock Size --- -••------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line _--.................. 1' REPAIR/ADDITION(Prey. Sanitation Permit# ____________________________________________ Date ----------------------------------) Septic Tank (Specify Requirements) ---------------------------------------------------------------------------------•----- ...... ...I.._...._----•.- \ --•------------- Disposal Field (Specify Requirements) ---�-��._.. z1.��1! c..___ ..... ..... ......... -----------------------o - --•- ----- • -- -------------------------- ----• ---• � 02 Cr�ing-ta-ndr q = ------ ------ - (Draw e re uia ition on reverse side) I hereby certify that I have prepared this 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 shall not employ any person in such manner as to become subject to Wo k an's Compensation laws of California." Signed --------------------------- ---- ---- Owner BY ---------- -------(If o----o--th--er--- --than--owner)- ------ - Title ��Lc C[ -c�1v------------ ------------. ....... ~� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ ---------------------- •-------------------------. DATE/A...-.77.7•-•................... ----------- ---- ----- BUILDINGPERMIT ISSUED ------------------•-------•-------•-•-----------•-------------- -•---------------------------------------DATE ........................................... ADDITIONALCOMMENTS -------------•-------------------------•-----------.....------•---_......._.........---------------------------------..----------=------------•--•------•---- -------------------------------- -- ------------•------ -••---•---•----•------•--------------------------•-•--•-----•---•-------•----------- t-------- Final Inspection by: --------------------------------------Date - ---._:. .- -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'AS RPV 5M