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FOR OFFICE USE: APPLICATION FOR -SANITATION PERMIT _..... ...........................------------- Permit No. 7�.....- y-�a' ........ .... � .. .......................................................... This Permit Expires II Year From Date Issued Hate Issued Application is hereby made to the San Joaquin Local'kealth District•_for-a per to construct and install the work herein described. This application is made-in-compliance with County Ordinance No. 549 and existing Rules and Regulations: i l JOB ADDRESS/LOCAONd. D..... ...1 f- _,............... .........CENSUS TRACT ... ........... # Owner's Namezt . T.........°.... ..... Phon .7f ............. Address . . .. ......._ . .' .. � ........ City . `r . Contractor's Name ........ .G ... '.- .. ... .... ::........:................License 9Pp5 .3.".Phone 7 �?. ./,.��.1 .. Installation will serve: Residence❑Apartment Hous@ C1 Commercial❑Trollor Court Q Motel ❑Other .. ... :.:. ,. ... i Number of living units.-...i------- Number of bedrooms ............Garbage Grinder...,......` Lio)t Size ....7. ..X-.2>................ Water Supply: Public System and name ........................................................_.............. G�rfs4fr....................Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Gay ❑ Peat❑ Sandy Loom 0 Clay loom ❑ Hardpan 0 Adobe Fill Material ............if yes,type ..... . O f j (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.l NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) PACKAGE TREATMENT .[ ] SEPTIC TANK V] s a Size......................... ...°... Liquid Depth ... It 1 , Capacity ---------------- Type .................... Material..................:.. No. Compartments =..................... Distance. to nearest: Well .Foundation ......... Prop. Line ..................... LEACHING LINE [ ] No. of lines ........................ Length of each line------••--.................. Total Length g ...................:......... : . . ......:..... D Box Type Filter Material ....•--------------•Depth .Filter,Material .......................!...................... Foundation . Property Line .: ......... Distance to nearest: Well ..................... .. ......._...........:... ...--••----- SEEPAGE PIT f ] Depth Diameter ............ Number ............................ Rock Filled Yes ❑ No Q Water Table Depth .. ................ .............Rock Size ..... ......... _................. 1 ...........Foundation I �"�`_...Prop."Line :................ Distance to nearest: Well.-----•------------------•---. ........._.. ...... ...._ REPAIR/ADDITION(Prev.S Sanitation Permit# � . Date ] Septic Tank {Speclfy�Requirements)------ ........... ................... Disposal Field (Specify..Requirements) .... _ x y ........................................................ X z�_x i Z 0. ................................•............ -----------..........................•-•------_--......--.................._............__.. ............ ..-_•.___..__....__..._._._..._..................._....._..__.,......_..........._..........- (Draw existing and required addition on.reverse side) I hereby certify that 1 have pr�epare3d his-0pplicatlor 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. Hence 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 t as to becorne subject to Workman's Compensation laws of California." Signed Owner BY .._.. Jit ----..._---- (If other n owner] _ F05 DEPARTMENT' USE ONLY APPLICATION ACCEPTED BY -- ..........................----------------------------------- DATE .. :: .. .4......:------- BUILDING PERMIT ISSUED-_ .-- -.-- ------- .DATE ...- ---.- AADITIONAI COMMENTS _/1. . �,I�. -._. :::- .------•--•.._..._.--•--_. ... ..............._.._.... ......... ......._..._..:.----.--•-- ..--.------.----........._.....------....... .._... ..__...------------.-........ .. -----------------------•-----..-•---- ......_. . ........................................................................................... --- Final Inspection by: -- i)ate _� .. 1--7k ................ 13 2 '6Rev. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M