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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT —S� 7 {Complete in Triplicate) Permit No. 7................. ........................................ &_�_ �y ................................................... 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/LOCATION1�.. �! ... r.............................CENSUS TRACT ........................... IOwner's Name . . .. �............................ ............. ...............Phone .................................... Address ............ ��. . ...,......... City .. ............... ---.......................-............ ..r_ License # J9.1.31> Phone Contractor's Name ..... .. . . ... ..... .. ... .. . .............. ..•- -�-----. .... ....................k...... .. '€ Installation will serve: ResidencApartment House] Com ercial❑Trailer Court ❑ '.� -R . Motel ❑Other ....... A-0- Number of living units:............ Number of bedrooms ............Garbage Grinder ............ Lot Size .-.......................................... Water Supply: Public System and name ........................................................... .............................. .4�� •..----------Private ❑ Character of soil to a depth of 3 feett Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ Hardpan ❑ Adobe ❑ 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: (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) E ] [ ] . Liquid Depth .......................... PACKAGE TREATMENT SEPTIC TANK Size............................................... Capacity .... Type Material.................... No. Compartments Distance to nearest, Well ................................•...Foundation ...................... Prop. Line ..................... LEACHING UNE [ ] No. of Lines .......................... Length of each line............................. Total Length ............................ D' Box Type Filter Material .....Depth Filter Material Distance to nearest, Well ........................ Foundation ........................ Property Line. ................... -. SEEPAGE PIT [ 7 Depth Diameter Number ............................ Rock Filled. Yes ❑. . No I❑� Water Table Depth .....................Rock Size ................................ ... � - Distance to nearest: Well ........................................Foundation .................... Prop, Line ...........:..........� REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ................................ .] Septic Tank (Specify Requirements) ....................... .. ..... . .......................................... ......................................... Dipose) Fiel (Specify Requirements) --- .s �- .r -- _ ...... .A. ....,,�.......................... �� .............."la" .......,.......:...... . .. . .......:..fid. ....... .. ................... ........... .................................. ................. .......................... ................ (Draw existing and 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 Son Joaquin Local Health District. Homi'owner'or licen. sed agents signature certifies the followings "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 W man's Compensation laws of California." Signed ......................... ........... / .........I...........•-• Owner ..._. By ..............................:. #.. ....! ..: .. ......:.. ..... . ........ .Title .J .. ................................................ lif other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ......... :..e........... ... DATE BUILDING PERMIT ISSUED _..... ...... ........•.................... . ::...:.......:....... .... ..DATE . . ADDITIONAL COMMENTS 6dF 7` .f`........... ... f`. s� .... .,<l.G......... ::.............. .............•........................................ .....-----------•----... ...... ...... :.............._...................................._.......-- ...................... InaInspection bY= &.r�................. . ................ . ................. .. . ..............................Date ...�x �, f�j................ SAN JOAQUIN LOCAL HEALTH DISTRICT e u 13 241 jo n... cu