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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -------------------------------------------- Permit No. 7�-//d {Complete In Triplicate) ............ .............................. . Date-Issued ......................................................... This Permit Expires I Year From Date Issued a 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 a Regulations: .� � r` /� N�i/� �p, JOB ADDRESS/LOC TION .._ i-._..n1�. �/:...�--1.'.- ............�� ._. � y ..s ...............CENSUTRAC7 .........-................ Owner's Name - - --J-�----- !,�i..---....:..........-�-----....................._.......,................. .. hone ........................ Address X3 .1` _t.. //� �� City �1v ci Y�!...... Contractor's Name Z' license 7� �5•-. Phone 7 ''"`"� ................ f .... . -- --------------------•--.--...---•--.. Installation will serve: Residence giKpartment House Commercial❑Trailer Court 0 Motel ❑Other.......................... ........ Number of living units:_..__j_._ Number of r ms arbage Grinder Lot Sine .../..�_., � ••••••••..•••. t ` �__ S,_It °°°Water Supply: Public System and name G� . .._..._ "`"`�--. .--.. --- .Private ❑ ..._ ... _. ❑Character of soil to a depth of 3 feet: Sand❑ 0 Clay Peat❑ Sandy Loam 0 ClayLoam i Hardpan 0 . Adobe• 1 Material , d:P._ If yes,type ..............• ........ T' Nrik, (Mot plan, showing size of lot, location. of system in relation to wells, buildings, etc. must be placed on reverse side. NEW INSTALLATION: (No septic tank or seepa pitpermitted if public sewer.is available within 200 feet,[ PACKAGE TREATMENT [ ] SEPTIC TANK ' Size------.' .--¢�i-------•-- Liquid Depth ' .- •.••-•- Capacity Type/. Mater€ap o. Compartments ........:.. D' nce.to nearest: Well ----..__ V�---------..Foundation .... .............. Prop. Line . ........_........ LEACHING LINE No. of Lines -- r-------------- Length of each line..V�' Total Length ./7a................ • 'D' "Box -,rJ... Type Filter Material _: . _Q. ....Depth Filter Material ..... 1 ........................... piston to!nearest: Well ... y ! .-__-... Foundation d._�........... Property Line .....--•.............•.. f SEEPAGE PIT [ Depth ._.�_�__r_.__. Diameter .. �'--- Number ..........��_........ Rock Filled Yes ��No j Water Table Depth / �` '' Rock-Size -_- % .J - ••--•-•- ' Q�yf� •rJ(J_-•------------- --.... Distance to nearest: Well ........4/_ -- Foundation ,� .�......_. Prop. Line ...- �........ REPAIR/ADDITION(Prev. Sanitation Permit#.— ---------------------------------------- Date ........----...................... 1 Septic Tank (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. Home owner or Ilcen- sed agents signature certifies the following: ".I certify that in the performance of the work for which this permit is Issued, I shalt nal employ any person in such manner as to become subject to Workman's Compensation laws of California." , Signed ......... ............ _ Owner BY .._.. ........................... Title _..... other n owner) FO TMENT USE ONLY f APPLICATION ACCEPTED BY"�_.... ..... v=--fel,........... DATE .... ............ BUILDING PERMIT ISSUED __ ` DATE ADDITIONAL COMMENTS ----- _ ------ J� " 7X.,:2�" -------------- ----- - ----------------------- ------...._......----- ................. --------- �.... 4 Final Inspection bY- --------- ---- - :........_:_.............-Date .: .......7�.._:�..._.. ... ' EH 13 2L x.-68 Rev. GNJ� 8 E SAN".10AQUI LOCAL HEALTH DISTRICT /7t1 3M • i ,: