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F FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT i (Complete in Triplicate) ,. Permit No. --- -- -I---- ------ --------- --- ----------------- - _-__- This Permit Expires 1 Year From Dates Issued 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 co Ii with County Ordinance No. 549 and existing Rules and Regulations: �l JOB ADDRESS/LOCATION __ 7 ___CENSUS TRACT -------------w a } ------------------------ -------------- ----- Owner's Name --------------- i3/tilC/_ ----------------- -------Phone Address I` ---/f----- ----- City - f.. Z__ZZ t - -------- Contractor's Name -______.. � ._- ____________________License # �,- 7� Phone __ _��S_ S_ _"_�_ Installation will serve: Residence ❑Apartment House[) Commercial Z/Trailei•Court ;❑ I' Motel ❑Other Number of livingunits:---_____ f/ �/ Number of bedrooms ---__.___--_Garbage Grinder __-_---- Lot Size 7"- -` _/i_.- Water Supply: Public System'and name ---------------------------------- --------•-------------Private ---------- ----------------------- Character of soil to a depth of 3.feet: _Sand'❑ Silt❑ Clay ❑ Peat- Sandy Loam ❑ Clay Loam .E] n - ' Hardpan ❑ Adobe 'E] Fill Material ------------ If yes, type ---------------------------- �. (Pot plan, showing size of ',lot, location of system in relation to wells, buildings, etc, must be placed on reverse side.] v) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,J �] PACKAGE TREATMENT [ ] it SEPTIC TANK'[ ] Size---/40�� (P_ -________ Liquid Depth -________---------- - --- Capacity -/,asoma_ Type fife-Ja4�-- Material_-- * No. Compartments _47t........:.... r Distance to nearest: Well -----� dh ---------------Foundation 10&1------ Prop. Line ._ -/ LEACHING LINE { ] No. of Lines ------------------------ Length of each line-----------------------.---- Total Length I ii 'D' Box ------------ Type Filter Material --------------------Depth Filter Material --------------------.--_--_-_-_-_-_-.--_,_. Distance to nearest. Well ------------------------- Foundation ----------------------- Property Line --------.----------_._.. SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ------------------- __--- Rock Filled Yes ❑ No i❑ Water Table Depth --------------------------------------• -------Rock Size -------------------------------- i Distance to nearest: Well --------------------------- --- ------Foundation -------------------- Prop. Line --------------....-_-- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- - ---- -----Date -------------- ----.----------------------------_-_ . eptic Tank (Specify Requirements) ---------- --- ------------------- - ----------------- ---------.-.---- rs osa re (Specify -- -- - ------ ------------•--- ---- _---------------------- --- -----.-----)-- ---------------------•--------------------------------- ----------- --- --- -------- - --- - -- - ----------- ---------------- - �- � - - _==----------------------- i (D aF w existing a 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 liven- 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 Compensation laws of California." Signed --- ----- --'r--- - - Owner l By -- ---------------- --------------- Title --- --- (If other than ner) 4 OR .DEPARTMENT USE ONLY APPLICATION ACCEPTED - - -- - - - -- - --------- --------------------------------------------- DATE - --- �---------•-- ---------------- ' BUILDING PERMIT ISSUED --- '=------------------- ------------------------•-- DATE -- --------------- -------------------------- ------------- ---- ---- -------------------------------------------------------------------- -------------------------------------------- ------- ---- - - ------- ----- ------- ---- ------- Final ------ -------- -------= Final Inspection by: --------- = - Date Z .i SAN J A UIN LOCA4,HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M