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r� ^ FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------------------------------i ' ------ 2_ P (Complete in Triplicate} Permit No. _7-Z�' Z____.. ----------------------------- - - - -----1- ------------------------------- ------------ -------------- This Permit Expires t Year From Date Issued Date Issued __7-.-1.`-__--Y f 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 existing Rules and Regulations: t 2 �e &,u- r n{�S E f f �f ` .C /�� ®� I 4 i-4�wlal'�ls�'_� "a`'� -CENSUS TRACT -------------------------- JOB ADDRESS/LOCATION ._ - .__ __ _ � _ , -- Owner's Name -r.r-� � _.._ -------------------------- --..Phone -�. . — - - Address ;.` e� City Contractor's Name -_--- -- - - ------------------------------ -- ---------License # � - Phone ----- --5 f Installation will serve: Residence []Apartment House-❑ Commercial :❑Trailer Court ;❑ Motel E_ her _ LWlr -Ie Number of living units------------ Number of bedrooms ------------Garbage Grinder ------------ Lot Size ------------------ - Water Supply: Public System and namt e ---------------------------------- ---------------------------------------------------------------------------Private, Character of soil to a depth of 3 feet: Sand'D Sift❑ Clay ❑ PeatX 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.).'_`b. NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) 1 PACKAGE TREATMENT [ ] SEPTIC TANKSize__-_'_-__!'?X�__xl ___________________ Liquid Depth ____'y_____-__.._._____ 1r s Capacity Type. -Material s 4--------- No. Compartments = es l Distance to nearest: Well _______________________Foundation __3o----------- Prop. Line -- --- .. x LEACHING LINE NA" No. of Lines :_ J ` _______________ Length of each line. XPG_�______ Total Length ;f ___ _ A._ , 'D' Box ____/__ Type Filter Material Depth Filter Material ---IS-_______ ______7______._.-_-- rt ___ Foundation __ _______________ Property Line --- ----. Distance to nearest: Well -s� _________ _____ j _ SEEPAGE PIT [ ] Depth ____________________ Diameter -------------- - Number _.___.____..__________.____ Rock Filled Yes ❑ No l❑ Water Table Depth ------------------------------------------------Rock Size -------------------------------- r ' Distance to nearest: Well ----------------------------------------Foundation ---------------•---- Prop. Line ....----•------------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------------------•------------} SepticTank (Specify Requirements[ ---------------------------------------------------------------------- ---------------------------------------------------------------------- Disposal Field (Specify Requirements) ------= -------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------- --------------------------------------------- - - ------------------- ---------------------- --------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) 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. Dome 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 bec dsul_c�l Iect too Wor man's Compensation laws of California." Signed 4 = h GGA. C�'� - - - ---- - ------ -�J - �- -- -�---------------------- Owner G' BY ------ ------� 'G_�---— /------------------- Title ------------ (If other thcrn owner) �FAPARTMENT USE ONLY APPLICATION ACCEPTED BY -_-- . -___- DATE a-�d1- '_______________ BUILDING PERMIT ISSUED ----- --- - ---- -- - ----- - -- - ----------------------------------------------------------DATE ----------------------------------------- ADDITIONAL COMMENTS -----I_A--- _____________ '=------------------------------------------------------------------------------- ------ ----------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------- ----- ----------- - - ---------------------------------------------------------- ------- ��},,ii - - - - --------------=------- Final Inspection by- I> I-& d'------------------------------------------------------ Date - --- --- ----------------- -- -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1 F H 0 1.'AA Pav 5M