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FOR OFFICE USE- APPLICATION FOR SANITATION PERMIT i (Complete in Triplicate) rc!r r+s r s�yl Permit No. -7 This Perntlt Expires 1 Year From Date Issued Date Issued .... f".��. Application is hereby made to the San Joaquin Local Health Distrlcfi 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/LOCATION .-..-. -.p_-%Z.a...._..�6,r-a_Zl Qs. --................ ...CENSUS TRACT ..............:........... Owner's Name F-.. .f'.fo.Yl..............................................................I.......-....................Phone ..! ..y.3•s • .z-....._ Address . _ .S..o- Z-O ....-/Vl fir, c._�ns.- - ... . ..... City s'.f'oG a- ..............................._..,......-.._ -_-._ nn Contractor's Name _...! '/`lS. 1. ` i .`i.S......................•-- ......L€cense # .X ... Phone Installation will serve: Residence�artment Housefl Commercial ❑Trailer Court j_] Motef❑Other ........................................... Number of living units:- 1__... Number of bedrooms __3Garbage a Grinder lot Size ....4s...:..................... Water Supply: Public System and name -•--••-----•--•--••........................._....-•---•••..-•..................................................Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay Peat❑ Sandy Loam {] Clay Loam ❑ Hardpan 0 Adobe Flll 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,) PACKAGE TREATMENT ( } SEPTIC TANK f Size..................... ... Liquid Depth 0 Capacity ........------ ..... Type .................... Material.............._....... No. Compartments ..................... Distance to nearest: Well ....................................Foundation ...................... Prop. Line ...................... LEACHING LINE [ j No. of Lines ________________________ Length of each line............................ Total length ............................ 'D' Box ............ Type Filter Material ....................Depth .Filter Material _....._... ................. Distance to nearest:-.Well ........................ Foundation ......................... Property tine ........................ SEEPAGE PIT { ) Depth .......... "Diameter -----__--•.. ... Number ............................ Rock Filled Yes ❑ No ❑ . R Water Table Depth -•---••........................:...........':Rock Size ................................ Distance to nearest: Well ... .................................... ..................... Prop. tine ...................... REPAIR/ADDITION(Prov. Sanitation Permit# Date ......____•.__•__•__•- Septic Tank (Specify Requirements) --__---_ ••-• -........:'--- --=-•-•--••-••--•-•-•--••••:.:.......:.. ..................... Disposal Field (Specify Requirements) ...___Y --_____ ..... .......... .. -------------------- ---•------------ - -- ----------•----_- --•--------------••-----------••--••-•-._.........__.._.-.._..---......... (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 Sart Joaquin Local Health,District. Home owner or llcen 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 mariner as to become subject to Workman's Compensation laws of California." Signed -------------•------------•-----•---------•--------------•-•--••-------------------__-,----..._.- Owner By -- - E ----..---•--•----...•-•------- Title s '-/,►'+,-a. a ---...-. other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYDATE ". � �' — ...-_-- - " ' ---------- BUILDINGPERMIT ISSUED ------------ ---------- .............................................................. .................DATE ..._-._... ------ -_--_--------------- ADDITIONAL COMMENTS ---------- --•• j�----------,- -----------------•--.. _..---- • •-•-- -•---•---.. ------------------------------ - ......... --;.n 'f1 ��.. ...........------------ -------------- ....................... ---------- Finat inspection by: . '?��'�'P ------------------------ ---------------•..-_..------..--.._.__.._-..-Date v' _.'/ .----_------- EH 13 2L 1-68 Rev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M