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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. _7______ _______ __ -------------------------------------------------------- This Permit Expires ] Year From Date Issued Date Issued 1�`��`---3 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: JOB ADDRESS/LOCATION .--------. LC -- ,r ,r------I 1�r t_y_____._____5 �_1 4-------------CENSUS TRACT -------------------------- Owner's Name ------- --------'a_�-t-3------- )94-I`er-�S- ---------- ---:---------------- Phone Address -------------- -111 / / f�% ------- = U t- ----------------------sJuC�Cf-'�,-----------•--. city 4'� Contractor's Name ----------vg,---)Y-- -----------------------------------------License #,::27_Y:-4_457_!P—Phone Installation Installation will serve: Residence impartment House❑ Commercial ❑Trailer Court Motel ❑Other Number of living units:----I----- Number of bedrooms _3-------Garbage Grinder ------------ Lot Size --f'2 ---- -- Water Supply: Public System and name ------ C-3Aye---rJ4------2. _C_k_41 ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt E] Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam ❑ Hardpan ❑ Adobe q 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT { ] SEPTIC TANK:[L]--` -:_._. --'Size____��^_y_�~ ; S �--�,:---.---.- Li uid Depth __ � =7-- ----- - q p ----------------- Capacity ---IA,)-1------- Type __ 1_��Rf_ Material-___- No. Compartments -__-. Distance to nearest: Well --------------------%--------._-+__Foundationl____./4)------------ Prop. Line __/cJ.......... .._._ ��jj LEACHING LINE [ ] No. of Lines ---------cam--------- Length of �ach/line.______ -,-'-_--Total Length D' Box ... 15 /_.-_ Type Filter Ma enal �1 �cDepth Filter,Material --------le-----------------........... Distance to nearest: Well _A1114----------- Foundation .�U___ ____ Property Line SEEPAGE PIT [ ] Depth -:7-:5 ------ Diameter _3_a__ Number -------�-r------------ Rock Filled Yes No ❑ Water Table Depth ----- `;' i Rock Size ------------------------------- Distance to nearest; Well __________________________-_---._______Foundation _._r---------------- Prop. Line ________..__..---.__.. � REPAIR/ADDITION(Prev. Sanitation_Permit# ____________________-_-_______�_____�-`_-- Dates _________�___-_ .----------- Septic Tank (Specify Requirements) ---- --- ----------- ----------- 1--- [ ------------------------------------------ -------------••- �• Disposal Field (Specify Requirements) '- . --------------- • -- -------- ---------------------------------------------- I --------------------------- --------------------- ----------------------------- -----=---------------------------------------- - ------------ - -- ------------------------- - - r -------------- ---- (Draw ekistiag and required addition on.reverse sidek E s� I hereby certify that I have prepared this application and that the wowil rk l be gone in accordance with Sart Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home 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 subjeto - orkma 's Compensation laws of California." Signed -- ------ -- By --------------------------------------------------------------------------------------------------- Title --- - --- ------------------------------------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------------- ------------------------. DATE --- -- ------------- BUILDING PERMIT ISSUED --- ---- ----------------------------------------------------------------- -------------------------- ---DATE ------------------------------------------- ADDITIONAL COMMENTS = -------- --- - ---------------------------------------------------------------------------------------------------------------------------------------- --------------------------- - ------- - ----- ' ------------------------------------------------ ------------ - --- - -- ------ ---- ---- Final Inspection b -----------Date -----------5� 3 ---------------- p y, -----==---- S^ - - -------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M