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' FOR OFFICE USE: ,. `APIPII'CATIC;N FOR SANITATION PERMIT f Permit No. ..-7 � ;Complete in Triplicate► ........................................ • Date issued ..�.`...."_.._.. .................... .„••, } This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made iin compliance with County Ordinance.No. 549 and existing Rules and Regulations.- JOB egulations:JOB ADDRESS LOCATION ....... .......I`!.! . ....:_...:” =.. -.r .CENSUS TRACE ........................ j r ' Phone ...Owner's Name Address ...._.. ..... .... Contractor's Name ...... j:_ :...` �;F�•SZ{ =f - 4» -A4 ...................License # 4` = . Phone` Installation will serve: Residence 23�'Apartment House C] Commercial ❑Trailer Court 0 Y ;� Motel ❑Other ............................................ 1 Number of living units:...:.t-.._ Number of bedrooms :-�........Garbage Grinder....---.---_ Lot Size -------------------------------------------- t ' E [ Water Supply. Public System and name .---•---•=--•-••f-----•-------------.......•-------..._..__... ..........-....-..------...••-• .. Private ❑ 4. Character of Isoil to a depth of 3 feet: Sand 0 - Silt❑ Clay Peat❑ Sandy Loam.fl.""Glay Lb rn ❑ , Hardpan ❑ .Adobe ❑ Fill Material ............ If yes,type ......... .................. (Plot plan, showing size of.lot,-location.of..syste�n_in_relation-to wells,-buildings, etc: must be placed on reverse side.) r NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,), ,� t PACKAGE TREATMENT [3] SEPTIC TANK Ij ); Size____________________••-• ....!........ Liquid' Depth ................ Tr , Capacity Type Material . No. Compartments ...:.-.._------ .......� ------- ---•--- ----- ._..... ---•-•............. k Distance to nearest: Well .............................•......-Foundation ....___-�___-_�_ Prop. Line ...._�.._...... . — -_. ; LEACHING LINE- [] No. of line`s-....... ..........::... f Lerigth�of'eaci} line.....................:.. TatalxLength. ' Box -- Type Filter Material Depth Filter Material . .DYP , Distance to3nearest: Well ........................ Foundation ........................ Property Line .................... ..(, SEEPAGE PITDe th [ � p --------............. Diameter _..._....... ... Number _-------------- ........... Rack Filled Yes ❑ . No.-b . • Water Table Depth ........Rock Size ' . ...... - Distance to nearest: Well ---•....................................Foundation .................... Prop.' Line .........................D REPAIR/ADDITION(Prev. Sanitation Permit# ............................. Date _.-........................I...... ) ..... Septic Tank ISpecify Requirements) 'c"`� �' + ' F i Disposal Field (Specify Requirements) ----- ..... ? �? - a a-.. --.--• ......................I——............ - ......................... �@ F j` ....�w`a'z? "' '............... ------.......................................... ----------------------------------------------------------..----------- .......... ........ ............................................... -------------•------ ............................................................................................... .... .. . ... (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be dune in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District.'Hame-owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to W rkman's Compensation laws of California." Signed ..-.... .. . . - .................... t1--1---------•------------------------ Owner BY ------------- .?.-. .. .. ��'si�- ---------------..-..-------..--•-.----- Title - a --------------------------------------................. I (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ..... :... ----------------------................................................. DATE .----__- BUILDINGPERMIT ISSUED ......... .................. ........._..................................=-----.........................DATE ........................................... ADDITIONALCOMMENTS -_---------- -_-•----- ..............•......................--_........--.------.......................................................................... ----------------------•------------- ----....................... . . ....................................................... .................... .................. ............................................. ---•-••• ..................................................................................... . .._. Final Inspection by: < . .. ._____.Date - N JOAQUIN LLOCAL HEALTH DISTRICT .. / :A r. u 13 241_-Aa De.. amt 7172 3 114