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' FOR OFFICE USE: � APPLICATION FOR SANITATION PERMIT . ECompiete in Triplicate! Permit No. 7.-..:.-,_::2_2..- / ...:......... This permit Expires I Year From Datel$sued Date,laaued ..............:�. 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 a fisting }Jules and Regulations: JOB ADDRESS/LOCATION .� .+_ .......................... "' CENSUS TRACT Owner's Name '. -.....................................•-- ........................................Phone ......... ,.,.,....,............... Address . .Q�•�� ::... .�,..... ..................City .........................,................................................. . Contractor's Name C ............... ...........License # f .. Phone Installation will serve: Residence Apartment Housefl Commercial OTrailer Court ] Motel-Q-Other - I ��` /�d . Number of living units:....------ Number of bedrooms .•_....Garbage Grinder ...:........ Lot Size -,�.....�............................. Water Supply: Public System and name -------- �. ----_._.._,.._.....�__�.................................I ,.,_ � .,,..: r rlvate Character of sail to a depth of 3 feet: Sand❑ Silt Q Clay o Peat Q Sandy Loom Q I clay Loam, F �Hardpan Q Adobe 0 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 aide.) NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK; } Size......... ..............__Liqulcl Depth CapacityTYPe :....._--•-------- Material...................:.. No. .:Compartments ....................... Distance to nearest: Well ............................•_••...•Foundation :......... ........... Prop. Line ...................... W s T LEACHING LINE [ ] No. of Lines ----- --------------- Length of each line----.__..:.--........ ........ T 6 S Total length ............................ s 'b' Box ...... Type Filter Material .-_---------------DeptOilter Material Distance to nearest: Well ........................ Foundation Property Line .............I.......... SEEPAGE PIT, { ) Depth 1` Diomete'r - —Number.............."u"" .............. //..... .. Rock Filled Yea No Q Water Fable Depth ............... ...-----Rock Size ._.! ....V_................ ... Distance totnearest: Well ............... ..._....._.__Foundation ..........._........ Prop. Line /0..................I REPAIR/ADDITION(Prev. Sanitationi Permit# -=.:---.------•---. ......._. Date ...........:....•-------._....----} Septic Tank {Specify Requirements) . -.....................•---------•---------------.._......_...... ...............:...................................... •__._..__..._...... Disposal Field (Specify Requirements) _--__- ••----------------------•-•• •. .... ---•---------------------• -- -------------..............................-.-.............................................................. ...._. -------------------------------------------- --------------- ---------- ----------------------------•--- ....................................... IlDraw 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 San Joaquin Local Health,District. Horne 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 Work an';Compensation laws of California." Signed -- =Owner BY --- --- - �.�--.- '` ---------------------_________ Title -- ...._....._. .--•------- If other than owner) 4 R EPARTMENT USI: ONLY APPLICATION ACCEPTED BY ------ ----- 'r " `" - DATE .......3 ..76: BUILDING PERMIT 'ISSUED _.:-'--------- --------------------- ----------- --------------- ------.------------ -------------.DATE .........._........ ................. ADDITIONAL COMMENTS ..............!._--..._ ............. ---------------•--- ----- -------------------------------------------------------- ----------------------------------------•......... ------ ...................•--....._....._...------••---•------..........._.......... i Final Inspection by: ------------ •----- .. . Date ......_.�.._��_ .. �.........---- ................... . . 3 EH 13 24 1-68 Rev. 5 SAN AQUIN :LOCAL HEALTH DISTRICT $/7h 3M I