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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - _ - 7�/� Y (Complele in Triplicate) Permit No. . . . ---- ........ .. ....... y ---. This Permit Expires 7 Year From Date Issued Date Application is hereby made to the Son 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: CENSU5 TRACT JOS ADDRESSAOCATIPN ... . .`f.. _.... ....... yf 7 j;� d Owner's Name ... Phone f� - Address ....... 7`� _ .... �•� .�..... - City ... !!. - .... ................................ Contractor's Name - / f. l?etc License# .17 � z!YI?11�. � _�t!1_--X-.lc. ......- Phone Installation will serve: Residence[Apartment House❑ Commercial []Trailer Court fl Motel❑Other. .............................. Number of living units:....... ... Number of bedrooms .. --.Garbage Grinder ........ -, lot Size .... ..................................... Water Supply: Public System and name -------------------------------------- --- -- -- -....._..... ----...................--- ---- Private 2-- Character /Character of soil to a depth of 0 feet: Sand j] Silt(a Clay ❑ Peat❑ Sandy Loom ❑ Clay Loam ❑ Hardpan❑ Adobe ❑ Fill Material------- If yes,type__-. .... ...... .. ...... {Piot 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( J Size... _--........................... . . Liquid Depth ....................----- r Capacity .................... Type .-................ Material----- --........... No. Compartments ...................... „} Distance to nearest: Well .,..................._.......-....Foundation .......- .. Prop. Line..................... f LEACHING LINE [ J No. of Lines ........--.----------- Length of each line---_...................... Total Length -_-.-..................... 'D' Box --_--_--- Type Filter Material ....................Depth Filter Material ................--_--_--.--.............. Distance to nearest: Well ........................ Foundation ..................-..... Property Line .............. --.. Z SEEPAGE PIT Depth ... DiarPheter ............... Rack Filled Yes No Q r f 1 p ----- Number ...................... ❑ Water Table Depth ...... ............. ......................Rock Size ........................... Distance to nearest:Well .................................Foundation .................... Prop. Line .....-._-------------. REPAIR/ADDITION{Prev. Sanitation Permit#.........................._--.............. Date ..........--------------------) Septic Tank (Specify Requirements) ...................-...._.... . :- ------------------------.--..-- ....- Disposal Field (Specify Requirements) G : _ V � 9 ..................... ........-....... ------------- --------- ._......... . .......... (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be don* 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 Workman's Compensation laws of California." Signed . .. ................ . ... .......--------.............. ................--...... Owner By . .- ... ............................... ......-------------- Title .._ .-.. .- - .-........ (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 8Y........... . .. .............- -- ......._. DATE ....a2 - BUILDINGPERMIT ISSUED .................. .........................---.............. ............-- .-......DATE...............- ----.................-- ADDITIONALCOMMENTS ...... ....................................... .....---------------------------- ------........ ................-..------ .......-....... -------------- - -------------------------------------------------------------..... --.................... ...-------.......... .............-.-.......... ...... .......................... ------------ ---- Final Inspection by: —6 ) - - - Dote ....... -- c , SAN JOAQUIN LOCAL HEALTH DISTRICT ��