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FOR OFFICE USE: ' CATION FOR SANITATION PERMIT Permit No. `7 a --------------------- - ----- {Complete in Triplicate} ----•------ i. Date issued�'.��-� Thi's1Permit Expires 1 Year From Date issue -------------- - ermit to construct and install the wor herein 4 Application is hereby made to the Son ,Joaquin Local Health District for a p• . described. This application is made in compliance with County Ordinance No. 5Q9 and existing Rules and Regulations: desc ] CENSUS TRACT N .,J�� - ------ ----------- --- JOB ADDRESS/LO s Phone Owner's Na ------------------------••-- --- -- --- - Address -------------- - -- -'-- - - - - __. Phone --------- -----------••------ G � - ___.License # -� -- --�- --------------------- Contractor's Name ------ ---- -------- --- -- ' Residence [Apartment House'[] Commercial ❑Trailer Court l❑ installation will serve: ; Motel ❑Other --- ---------------------------------- rooms --- -----------------------•-- ------ ----__-Garbage Grinder .----.------ Lot Size ---- - Number of living units:-----�- -- Number of bedrooms -----Private [ Public System and name --------------------- Water Supply: Y Sand Laam ❑ Clay Loam Cl ilt Clay❑ Peat ❑�Y - �..- -- Character of soil to a depth of 3 feet: Sand_''VAdobe ❑` - 'r] Fill Material --------- -- 1f Yes, type Hardpan buildings, etc. must be placed on reverse--------------- side.) r 1 (Plot plan, showing size of lot, location�of�system in relation to1.0 e W it ermined if public sewer is available within 200 feet,] NEW INSTALLATION: (No septic tank or seepage p�p . _ „_.... --- - -- - Liquid Depth ( PACKAGE TREATMENT [ ] SEPTIC TANK'[ 3 Size-------------•-----•----- ----- ---------- -- - ► (� Type -------------------- Material---------------------- No. Compartments ---------------------- Capacity --------•------------ Ca acitY -------- ------- - i -Well - --------'-----•-----------•Foundation --------- ----- ------ Prop. me -------•-- - ------ Distance to nearest: -- -. 4--each . Total Length ----------- ---------- LEACHING LINE [ ] No. of Lines ------------------------ Length of each line------------ ' � ------------------------------- Depth Filter Material ------------- 'D' Box ------------ Type Filter Material -------------------- 1L..._.---. _-- Property Line` -----------------...---- Distance to nearest: Well ------------------------ Fou Number �r .� No 0 Depth -. Diameter --------------�- Number ------------- -------------- ---- ----- -- Rock Filled Yes ❑ SEEPAGE PIT [ ] --------- - ~~ Water Table Depth --------------------------------- Rock-Size-= ------------------------- --------------- ---•------------------Foundation - ----- Prop. Line -------- ------------- Distance to nearest: Well _.__-___ -.- . . Date ------------------------------- REPAIR/ADDITION ------•-----------•-----------REPAIRfADDITION(Prev..Sanitation Permit# ------------------ _:------------- -•---------------------------•- ----- Septic Tank (Specify Requirements -.------- -• ., : - -------- ��------- --------- ------ ----- - Dis o al Fi Id (Specify Requirements] - ( ------------ ----------------------------- ------------- D ------------- __ �� W r ---------- - _______ Z - Ptiing'a_n_�drequ Rllto � [ aweired addition on reverse side}�. certify that I have prepared this application and that the wo I hereby cerk will LocaloHealth D strte done in nHometowner or lce writh Son uenn fy s of the Son Joaquin County Ordinances, State Laws, and Rules and Regulation Joaquin sed agents signature certifies the following: ] ' ermit`,is issued, I shall nate ploy any person in such manner "I certify that in the performance of the work for which this .p I as to 6eco subject to Workman's Compensation laws of California." f ---------------- Owne --� + =-- Signed - - - -- --- -- - ----- ---- Title - --- --- ---- _ ------------------------------------- ------ By ----- - - --- `T- -- (If other than owner} 5.•1� � s'.J .FOR'.DEPARTMENT USE ONLY -79---- DAT------------------- E �� -- - ---------- APPLICATION ACCEPTED BY DATE - ----------------- ---------- -- ----------------- ----------- --------------------=--------------------------- BUILDING PERMIT ISSUED --------------------------------------------- ------------ -- -- ----- - - ---------------___ -- --------------- ADDITIONAL COMMENTS --------------------- -------------------- ------------------------------------------------------------------------ ------ ---------- ------------------------------------------------------------------- i------- - ----------------- --------------------------------------------------- ----- -� - Date Final inspection by: --- SAN JOAQUIN LOCAL HEALTH DISTRICT 5 E. H. 9 1-'b8 Rev. 5M