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FOR OFFICE USE: APPLICATION. FOR SANITATION PERMIT -----------V------------------------------ ------,-,-- [Complete in Triplicate) Permit No:7_�__-Y_/--F --- � I 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: W?X JOB ADDRESS/LOCATION � -��--� ------- ,---f _ i1`` ,. --------------------CENSUS TRACT -------------------------- t Owner's Namerla,:� _x,! — ------ t -- ------ yam. Phone s � ------------------------------------- Address - -D � --- /� ' �/�' City _ - sig - , Contractor's Name --- Q �= A05,77�4_17 - -------.License #rill3_� Phone��7_ �f' ��' 0 Installation will serve: Residencex Apartment House❑ Commercial :❑Trailer Court '❑ k Motel ❑Other ----------------------------'--------- ---- Number of living units:--/------ Number of bedrooms �------Garbage Grind �'erfl -- Lot Size Water Supply: Public System and name ---=---------------=------------•----- ------------------------------------------- ---------------------------Private rrx Character of soil to a depth of 3 feet Sand.❑ Silt❑ Clay` ❑ Peat❑ Sandy Loam ❑ Clay Loam] ` .F Hardpan ❑ Adobe'❑ Fill Material ------------ If yes,type -_---------_--------------- ht r � (Plot plan, showing size of dot, 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,) PACKAGE TREATMENT [ ] iSEPTIC TANK' Vie- _e ---------------- ---- Liquid DepthV -------- Capacity444 -__ -_ Type Material lj _^____ No. Compartments _ •-----• �. -Distance to nearest: Wel ` Foundation l --- Pro Line R LEACHING LINE ridNo, of Lines -___�-------------- Length of each line--C ------------- Total Length ,1-7 - __-___--.__ k Z 'D' Box f°_+�__ Type Filter Materiall- Depth Filter Material_----------------------------------- piston a to�nearest: Well Eoe -_ ----- Foundation �� ------------- Property Line SEEPAGE PIT [ j Depth Z67 de--------- Diameter __ Number __�------------------- Rock Filled Yes ' No C ff LF I Rock Size -^ Water Table Depth _-�sf�---�_ -------�-----------• -•---- ----- --f;----- Distance to nearest. Well ___ �.�P________--__---___- __ _---_------ Pro Line'_____.._ Foundation p. REPAIR/ADDITION(Prev. Sanitation,Permit# -------------------------------------------- Date ---------------•------------------1 I SepticTank (Specify Requirements) -------------------------------------------------- ----------------------------------------------------------•--------------------------- Disposal Field (Specify Requirements) ----------- ---------------- - ------------------------------------------------------------------------------------------------------ - --- ------------ ---------- ----- I ------------------------------------------------------ I[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 San Joaquin Local Health District. Horne owner or licen- 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." , s Signed ----- -- ----------- -- ----------- --------------------------------- Owner ------------------------------------ Title � �ja BY - ��`--. - - = ----------- ------------------------- - - (If r t an owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---C. ---------- - ---- ---------------------------------------------------------------- DATE ----- --� BUILDING PERMIT ISSUED -------------= -----DATE ----------------------------------------... ADDITIONALCOMMENTS ------- ------`------------=----------------------------------------------------------------------------------------------------- ---------••------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------- - ------------------------------------------------------------------------------ ------------- ----------------------------•----- ----------•--------- ------------------------------- -- ---- - -- - ---- _ '[1 -------- ----- -------- --- - Final Inspection by: ---- ----------Date -- ----------�--------- ---- -------- SAN JOAQUlN LOCAL HEALTH DISTRICT �. E. H. 9 1-'6$ Rev. 5M