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FOR OFFICE USE: ,/ � FOR OFFICE USE: ._ y APPLICATION FOR SANITATION PERMIT q Permit No---7-"C.:`_-- (Complete in Triplicate - ------• ----•---------------------- - _.� Date issued......l........"..---7 .......... w j `1.his Permit Expires 1 Year From-Date Issued 'Application is hereby made to.the San JoaquinLocalHealth 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: � ~, 4 e =---------------CENSUS TRACT. ---------------- - JOB AbDRESS/LOCATID ----- Phone....... ---- ' - Owner's Name.- ..... City .. ------------_----- _. . dress - � ... - _ i City. --: - ---- Zip Contractor s Name:.. _ .. License # D- l?'/ Phone .7.—,, . . 1 Installation will serve: . Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ " Motel ❑ _ Other.... !! '"...Number of bedrooms---.1 .. Garbage Grinder-. :..... 1at Size.,'© - .1.. .. Number of living units:_.._'. . P A -. k. Water Supple: Public System and names_ rivate ❑ Character of soil to a depth of 3 feet: Sand ❑ Silt.❑ -Clay,❑. -Peat ❑; -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. mus# be placed on reverse side.] NEW INSTALLATION: [No septic tank or seepage pit perrnitTed•if public sewer is available within 200 feet,] r„t PACKAGE TREATMENT [ ] SEPTIC TANK I .} cr- Size.............. ......--- ----- -" --- ------Liquid Depth._..:-.--------------------1A i .Material.- -- ----------- •:No. Compartments-----._.:.- - Capacity...._.. .... ---TYPe---- -------------- - Distance to nearest: Weil--------------- -........... ..Foundation........_. : .__......... Prop. Line.....:...._......----- ---- € ------------ N f NE [ ] No. of Lines -.--- -.-- `-- - g ----.--_.-•--.Len th-of-eaeh�I•ine.,---�--..: . .......:....Total Length LEACHING LI Box.. Filter Material:.--.--. ...... - .Depth Filter Material-- ------, i-._�:-___-:_ _--__---------- ------------- . k Distance to nearest: Well...._------------------- - .Foundation----------------"----- -----Property Line-...... SEEPAGE PIT [ ] Depth-- .........,..Diameter------------- -...--Number....---------------------------- Rock Filled Yes E] No E] l Water Table ;Depth.----------- -- --------...Rock Size.... ....... ... Distance to nearest: Well---------....--------...:------. .... -----:Foundation..... ........ . ........Prop. Line----------- ------ --------- REPAIR/ADDITION (Prev. Sanitation Permit#..............................---.- --- --- ----.Date.-•----...-•-- -- ----------- ------- r Septic Tank (Specify Re uirements).--- .:.- ---- f (r----- .. O Disposal Field (Specify Requirements)_......_ -. -- ................................. ,. — ---------- -_ e. ..�----- .. . (Draw existing and required addition on reverse side) t 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 licensed agents signature certifies.the following: ! r "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 Workman's Compensation [aws of California."' Signed_.. ----- -- ----------- Owner t_ Title... ......... --------- .... (If other than owner) ' FOR DEPAR MENT SE ONLY .._�.- `��q APPLICATION ACCEPTED BY.-------. ---- , G ----- DATE..... . d --- ....... . ...... DIVISION OF LAND NUMBER .............. .............. ..- __----.DATE................ ........ ADDITIONAL COMMENTS.... ....... 1 . ----.......--- __.. i, - ...............--- - - ------ ------- ......................... ........ --- --------------------- . ... ....... . .". .-. .- Final-inspection b k/ F&5 21677 REV. T 3M Ex is 2A SAN JOAQUIN LOCAL HEAL TRICT