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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT . Permit No: _7--fir.-"--7�---r•-S r--------------------------- -- ----. ---- (Complete in Triplicate i ---• Date Issued _`_I_ ----------- i This Permit Expires I Year From Date issue Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein I application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: described. This app • p JOB ADDRESS/LOCATION . � y'(,�'`I ,L i' ! �; ,Y;zi '-, r NSUS TRACT ? --------------------------- /? y _ Owner's Name ------ � sem- e -------- -------•-- �f= l Zf _l �-� -------------------------- -- City -1 -1 __ , i Address _ __ _ -------- G7 �� License #� - Phone --- ----- -- Contractor's Name Installation will serve: Residence ❑Apartment House,Lg Commercial❑Trailer Court '❑ Motel ❑Other -------------------------------------------- Number of living units:-------- -- Number of bedrooms ------------Garbage Grinder --- -------- s___ Lot Size --c------`-:--_- --- ------- -------Private C l. Water Supply: Public System and name __________________Silt_"______-_____Clay ' . ❑ Character'of soil to a depth of 3 feet: Sand'❑ ❑ Y ❑ Peat❑ Sandy Loam Clay Loam-v , . Hardpan (7Adobe ❑ Fill Material ------------ If yes,type ---------------------------- ! (Phot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) t I NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) — Size � ��--- Liquid De _ PACKAGE TREATMENT j ] SEPTIC TANK'[ ] �. k Capacity .� �s ----- Typed Material - No. Compartments Distance to nearest: Well 675--------- -Foundation _ -------- Prop. Line --- ----• Length _ ------ -------- LEACHING LINE [ ] No. of Lines -----/_____________ Length of each line_--- --�-��-- ---- Total Len g D' Box ------------ Type Filter Material I �- '-Depth Filter Material -----/3;.---------- -- I `�------------- Property Line -- Distance to nearest: Well ___-_sem __.___- -- Foundation -- t l Depth Diameter -- Rock Filled Yes No SEEPAGE PIT [ 1 p --- Number -----' ---------'------ � \ ------Rock Size ------------------------ - �. Water Table Depth ------------------------------------------------ - - ______________________ Foundation Prop. Line -_-•----------------- Distance to nearest. Well -------------------- ) REPAIR/ADDITION[Prev. Sanitation Permit # -- 3 --- Date --------------------•------------- � /Z` � Septic Tank (Specify Requirements) ----- --------- ---------------- I Disposal Field (Specify Requirements --------------- -- ------------------------- -- ------------------------------ ----------- -------------------------- ----------- r -------------------- ------------- ---------------------------- --------------------------- (Draw existing and required addition on reverse si e I hereby certify 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 shall not employ any parson in such manner as to become subject t Wor an's Compensation laws of California." Owner Signed ------- ------ ------ - ------------------------------ -- ---------- Title --------------------- -------- ------------- ' (If other than owner] + FOR .DEPARTMENT USE ONLY DATE - -��•- ----------------- APPLICATION ACCEPTED BY -- -------- --DATE ----- BUILDING PERMIT ISSUED ---------•-------------- - ------- ADDITIONAL COMMENTS ----------------------- --• --------------------------------------- ----- -- - - ---------------------------------- ------------ ---.------------------- ---------- -----' --------------------------------------------------- i------- --------------------------------------- -----�� •----------------- -------------•-- --•-------- 9.—%,n7 7 Final Inspection b ----------------- ----------------- -•------------- ----- --- SAN JOAQUIN LOCAL HEALTH ISTRICT C,' r u 0 1-'b8 Rev. 5M