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FOR.OFFICE USE: =''-A-PI:UCATION FOR SANITATION PERMIT i3 Permit No. 7.5�. ....�.... ....... -----••"...................................... (Complete in Triplicate) Dote to Issued .4.... .... This Permit Expires 1 Year From Date issued ........................... ............ A ............ lication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This opplic ttin is m e in compli ith County Ordinance No. 549 and existing Rules and Regulations: CCccaa _ i/ . ....... ............CENSUS TRACT .. JOB ADDRESS/LOCATIO "� _ .... . .Phone...._•.............. Owner's me Na �I-_ ... .. . . � ...... g r 1 . .. City -•-- ...._. Address .-.-..:° ...... ............License # .............. ... Contractor's Nome ---------0e. - . . _ --- � .�� 0 Installation will serve: Residence❑Apartment House' Commercial ]Trailer Court ❑ . Motel❑Other ---------- =_'.:. ............... i Number of living units.. Number. of bedrooms __�___...---Garbage Grinder ..-.....____ Lot iz ............... jk_ Water Supply: Public System and name .............................................• -- •-- -•Private Character of soil to a depth of 3 feet., Sand.❑ Silt❑ _Clay ❑ Peat❑ Sandy Loam Clay Loam4b - Hard an_, Adabe (] Fill-Material_....... _. if_yes�ty pe .................... --- .a.. ,.x ,. .. buildings, etc. must be placed on reverse side.) (Plot plan, showing size of lot, location' of system in.relation to wells, ; NEW INSTALLATION: (No septic tank or seepage pit permitted .if public sewer is available within 200 feet,} F Size.fb.-"�._±7f!o.-....y............ Liquid Depth ..7.......... ....••.,_ PACKAGE TREATMENT ( ] SEPTIC TANK�� 00 e � Material---------------------- No. Compartments _.._...... __....... r , Capacity . TYP ! Foundation ..... .1..._------ Prop. Line --• .............. Distance to nearest: We - -. - ----•-•-••-----------....... ---- Length of eatdine----1 5..6._-----. .--- Total Lengthµ... © ..---•-----•_-• LEACHING LINE ] No. of Lines ------------------------ g / - f- .. + Type Filter Material j .Depth Filter Material _: . ........... _•.-. _ + 'D' Box . - foundation �® Property line :..-•-- ..... Distance to nearest: Well .. A.... SEEPAGE'PIT [ ] Depth -------:............ Diameter Number,_............... Rock Filled Yes ❑ No Q Water Table Depth Rock Size .....................------------ Distance to nearest: Well ................................. Foundation .............. Prop. ,line-_--•----------•----5 REPAIR ADDITION Prev. Sanitation Permit�# .... Date ---•........ ..............•-•-•-_1 ! ...-------- ••••. ....... . -----••-•-• --------_------_------- Septic Tank (Specify Requirements) ...................-----.....--------•---------•-----.._..-... Disposal Field (Specify Requirements) ..-......................................................... --••---...---------..-------=-..-.-_..... ----.............. -------------................................. I, = %itDraw existing and required addition on reverse side) � 1 hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, andRules and Regulations of the San Joaquin Local Health District. Home owner or iieen- sed agents signature certifies the following: "I certify that in the performance of a work for which this permit is issued, I shall not employ any person in such manner as to a object to Wor an's Compensation laws of California." Signed ----- .................. Owner ��--- '- Title ----•.............. ...-....."...---:.-.....-.._...... --.... -- ---•••••...... ............ . I (If other than owner) FOR DEPARTMENT USE ONLY - , t APPLICATION ACCEPTED BY ----- ---- ....... ................................................. �AT `.... ...7Y....--...BUILDING PERMIT ISSUED ------------------------------••--:........-----•--.... •--••-.... ... :_:_. ............ ADDITIONAL COMMENTS =------............................................. . :::::---::::---......-:::::...........................::�::::..._A--_------ -------------------- -------.....A_-. - ::::::::: --- /.....................................- . ........ Final Inspection by: �. . 09 .................................................. ---.......•....................•---•....----•••--Date . ........... .. SAN JOAQUIN LOCAL HEALTH DISTRICT 7172 3 K Cl. -�°