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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT G ' No. 7 ..................................................... .{Complete in TrlplicatM) PerrnIt . . •---.. ....... This Permit Expires 1 Year from Date 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 compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCA IC}N ..I. _g+ _.. .. pro ..... - .....CENSUS TRACT ........................... Owner's Name _.. -- -- --------- -- --- ... .............-----*........._.....,.. ..........Phone ...-..........-..................... CAddress ... J�r?�' .t--•- .•• t. . ................ ---- .._. City *'�`" *��.. Contractor's Name -- - -- • -•--•- -- . • .............• �... . � License - Installation will serve: Residence[6Apartment House f] Commercial❑Trailer Court Motel ❑Other............................................. Number of living units:..... Numberof,bedrooms ---P.—.-Garbage Grinder ............ Lot Size ..:.....•................... ................ Water Supply: Public System and name ............ ..................................................._ ...... ......... _:'.:-......Private [� Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ hardpan p. . Adobe 0 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: (Nc septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT' [ ] SEPTIC TANK f ] Size-------------------------------------------•..... Liquid Depth ......_.............. ..... Capacity material...................... No. Compartments ' r •---••--•--•-- Type -•--•-----•- -....- --- 10 Distance to nearest: Well ....................................Foundation .. Prop. Line LEACHING LINE No. of Lines ------------------------ Length of each line............................. Total Length ............................ 'D' Sox ............. Type Filter Material ....................Depth Filter Material ............................................ z Distance to,nearest. Well ........................ Foundation ........................ Property Line ........__. .......... SEEPAGE PIT ( J Depth .................... Diameter, ........ Number ---------------------------- Rock Filled Yes ❑ No i[] .,� Water Fable Depth ---------------- - .............................Rock Size ............................ Distance to nearest: Well ........................................Foundation .................... Prop. Line...................... 4 REPAIR/ADDITION(Prev. Sanitation Permit Date ..................................) Septic Tank (Specify Requirements) ........................................... Disposal Field (Specify Requirements) ... et.---- - - .�.. �b ------ --•- -- ---- -- - - ------- •---- -.-.. . . . . . .----- ---- -- . . - {Draw existi-ng and required addition. . . ..on. ..reverse side. ........) a I hereby certify that I have prepared this application and that the work will be done In accordance with San Jac p County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health;District. Home owner or licgr 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 subject to Workman's Compensation laws of California.,, Signed ------ ------•-••------------------ ........ • Owner BY _ Title �. --_-1.1-.--•-•--•----•----------------------------- (if other than owner i. .. ._. G s EPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ..---- - .... DATE . � -_, BUILDINGPERMIT ISSUED -------- ------- -------------------....... --- -------------------••....... --------------DATE . ------------------ ....-----..-_.. ADDITIONAL COMMENTS ----- .......-............................• - = ---------------------------------------•-••--- ---- ----------------------------------- •--- Final inspection by: - --------- Date _s _:.�� --- ' 3 21a 1--6#3 Neu. I SAN JOAQUIN LOCA! HEALTH DISTRICT 8/7b 3M