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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT f�(� e.� Permit No. 7.--` 7 ?-y .......-...1 ................................... (Complete in Triplicate) .......: �a ..---- ---,_ Date Issuec ....•- l�0�•r /(/ This Permit Expires 1 Year From Date Issued 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: I�°, -.7".... ...CENSUS TRACT .......................... JOB ADDRESS/LOC TION .... .. ........... ... ...................... w . ?hone Owner's Nam ,..... .... .. .. 1� ............................ `�Clty --- .......... Address ..`.... p� Contractor's Name .. _ . �"y''` License # .�O-. Phone .............................. ... :..... -= ro infstollotion will serve: Residence [3 Apartment House'❑ Comme cir of ;❑mailer Court Motel ❑ ... ... Other ........yw ...... • Number of living units:..--/...... Number of bedrooms 5......Garbage Grinder .... ....... lot Size ............... Water Supply: Public System and name ..... ...............................-- ----- ------------.---:....._..----_....._--........- .:.............:..Private Character of soil to a depth of 3 feet: Sand b",/Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam I Hardpan Adobe 17Fill 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 seep pit permitted If public sewer is available within 200 feet,} !� / X ° Depth ...q. ---....._... 6 l PACKAGE TREATMENT j } SEPTIC TANK [ 5ize-_ .. .gip....... .. .............. . I . . Liquid De � No. Co artments ... =......:.... Capacity f&OPt Type .... Material j.�,-• p / Prop: Line Distance to near Weil © ................Foundation .... -. --.--------- . i LEACHING LINE [�No. of Lines ---- ....... Length of each line.._'_ . k....- -----• Total Length .:.�.----•----• - f �e D' Box /.`_.. Type Filter Materia# ..---•Depth Filter Material .__-.� ......:........`.........:... f ••... ..... .. Distance to nearest: Well ! Property Line. Foundation 0--=----- ......... . ....... -_- Rock Filled Yes Na i❑ SEEPAGE PIT- E Depth _._C .�•.-.. Diameter _. ..: Number ....... .. Q . Water Table Depth .. �.Q ......... Prop. Line ..�.. Distance to nearest: Well Lop Founda`t€on .�..... ---•••--•••••- j REPAIR/ADDITION(Prev. Sanitation Permit�# ...... Date - ........._..... --. ••----------------•----•----••- -} Septic Tank (specify Requirements) ...•___-..,_••-•-•-'-----"-----'----"""""_ -----•-•--•--•..................._..---•--------••. I ,. .. ♦ # .................. Disposal Field (Specify Requirements) ..... .. ........... .........---..........--•-....._._........---------.._,----------••••-------...:.----..------ ................................ - (Draw existing and required addition on reverse side) 1 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. Horne 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 as to become subject to Workman's mpensation laws of California." Signed ._.. . Owner ,. ....................... Y ._. .. (If other than owne I FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY ... .••-••.,.......................... .................... DATE ._ .' .. " ..DATE BUILDING PERMIT ISSUED ................... ..........._.._........_._...._._.._ ADDITIONALCOMMENTS ....................... .........................................................................................:.. I . ..: ............................... :._--------__-....----........-----.....----.........-----....... ...................................._ ......._......... _....... ... .. Date . ...-..lz -- Final Inspection by: T SAN JOAQLIIN LOCAL HEALTH DISTRICT u 13 24 1_•AR ap....SM.H _- -. 7172 3-H .