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FOR OFFICE USE: A.APPLICATION FOR SANITATION PERMIT 7 z-3Y3 --------------- --- Permit No: ^•' (Complete in Triplicate) �3- 3o- 7L Date issued - ------------------ --_ # This Permit Expires 1 Year From Date Issued Application is hereby madeYo the-Sa 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,, egulations: 10 ENSUS TRACT ------`------------------- JOB ADDRESS/LOCATION'•__O Owner's Name ----, �1 �f2------: �----------------------- -------------------Phone'---_�--------_---- ----------------- Address --------:-.---. r � Address ---- s? city /-�l�l!� --------------------------------------------- I/ ------------------ -------- Contractor's Name d'f� �` ° ------------------------- License # �� Phone -`�- �' Installation will,se e: Residence ❑ Apartment-House Commercial []Trailer Gee"- ' �'f Motel ❑Other ,5/I��----pf � Number of living units------------- Number of bedrooms - ``__--_Garbage Grinder ---------- Lot Size --------_-----_---_--_-_-----------__----- Water Supply: PublicSystem-and narne7 !---P4�'' lwn ee oa - ClayLoamriv❑ate ❑ Character of soi l to-a depth of 3 feet. Sand ❑ Silt❑ Clay ❑ _ ❑ Y ❑ } 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.) I0� NEW INSTALLATION: (No septic flank or seepage pit permitted.if public sewer is available within 200 feet,) / C SEPTIC TANK Size: { - �" ' . liquid Depth/r= ----------- --- - PACKAGE TREATMENT ( ] -is ' Capacity ---- YP ----� ----:f � 1 r. Foundation ------------------�-- Prep. Line.---------------------� L, Type MatenaVe jd-�� No. Com artments Distance to nearest: Well ___----____ - j Y . LEACHING LINE No. of Lines ------------------------= Length of each line--_-' --------- ---- Total Length _ `--------------• Box/V�--- Type Filter Materia!` .f��-Depth Filter Materiafi/ �----------------- :----------_----- 'D'Distance to nearest: Well _' ---_--_---- Foundation . i - ----------- Property Line '11A ::............ • - . , SEEPAGE PIT i/1 Depth a� --- ------- Diamete` N tuber ____ _�-____��--___.___Rock Filled '-Yes ' No Water Table Depth --- ._-__-••.Rock Size`__--_ ''. �-� - ------------ ll Distance to nearest: Well __-`7--'----------- ---•-_--Foundation __, -____.______ Prop. Liner-_.-- ------------ r V. F •� i � _ � 1 I it PAIR/ADDITION(Prev. Sanitation Permit# -•---------------------- ---------- =`-- Date ------------=:- - --------- Septic Tank (Specify Requirements) ---- -------------- ------------- ----------------------------------- ---- -------------------'-----------' ---------------=-------- Disposal Field (Specify Requirements) -------------- ----------------------------------------------------- -------_--------------:- ------------=---- ------------------- ---- -- - ------------------ ---------------------- ------------------- -------------------------------- (Draw existing and required addition on reverse sidd) I hereby certify that I have prepared this application and that the work will beoacne in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the. San Joaquin,loca! Health District. Home owner or Iicen- ,{ 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 anygperson in such manner as to become subject to Workman's Compensation laws of'California." Signed ----------------------- -------------------- Owner - _.. I By Title + �------------------ 3 {If other than A/ FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- -=----- ----------------------------------------------------------- ------------ DATE ..- : ;--,BUILDING PERMIT ISSUED --------------------------------------------- -------------------I----------------- ----------------------DATE I ADDITIONAL COMMENTS ------------- -------- ---------------------------- ------ --------,-----=,-- •-. ------------------------------ -------------------------------------------- ' ---------------------------------------- ------ -- - - - ------ ---- - -- Final,Inspection b ------- .r---------------------------------------,=-- ------------------ Date P Y� ---- SAN JOAQUIN LOCAL HEALTH `DISTRICT r E. H!9 1-'68 Rev. 5MA.