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FOR OFFICE USE: I APPLICATION FOR SANITATION PERMIT 7S y i....._ ... _.-• \ Permit No. .. (Complete In Triplicate) ...__. ........................................ . _ -bate Issued...6:— s-�4, ' This Permit Expires 1 Year From Date Issued .... Application is hereby made to the San Joaquih 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/LOCATION .� .............. ..._..�. 1..1� '�—.........................CENSUS BRACT .......................... Owner's Name ------ ._....... � ..1.. .._.... .............. ....... _Phone'. ....... . ....-........_......... Address � f._ . �� Viz... City t�-j� 1 Contractor's Name .._� ._.License*s ..?/-,1;: ..J'.. Phone .._. Installation will serve: F Residence CRAportment Houseo Commercial❑Trailer Court ❑ .• Motel Q Other Number of living units:_.. Number of bedrooms ...V7--Garbage Grinder f't,-R... Lot Size Water Supply: Public System and name ..--• -----,c e_,- L-------------•-..........................................Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt[# Clay - Peat❑ Sandy Loam 0 Gay Loam ❑ Hardpan Q Adobe Fill Material ............ If yes,type............... ............ F (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be.placed on reverse slde.) �`- NEW INSTALLATION: (No septic tank or seepage pit ,permitted If public sewer.is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK Size................................................ Liquid Depth .................... __ Material---------------------- No. Compartments ............ Capacity ---•--------------- Type ..._...-•--------- .......... 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 ..................................... ....... __•__ -o ...........arest. Well ............. Foundation ......................_. ---._............_...... Property Line `! Distance to nearest. W SEEPAGE PIT O Depth __-__-- Diameter ............... Number ............................ Rock Filled Yes ❑ No OJ— Water Table Depth ....................... ..._----------•--.-_Rock'Size •--------••••---•... ........... 4_7 Diadffee to nearest: Well _...:.......-_• ...foundation .:...... Prop Line ...................... REPAIR/ADDITION(Prev. Sanitation. Permit# -------------------------------------------- Date .......................:.......... } . Septic Tank (Specify Requirements).................... •-• .... .......... --- •. ...........................................-.-=------- Disposal Field (Specify 'Requirements# �j' " ----- ---=-------- - ------ -------------_-__ ---- — r ---------••----- ----- ------------------ ------ -------_ ....... - ------------------------.......................................................... i ;Draw existing and required addition on reverse side) ! I hereby certify that 1 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. Home owner or licen. 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 ... (If other an:o ner RD RTMENT USE ONLY " APPLICATION ACCEPTED BY _ -•-- -- --•- -- -• - ----- --- ------------- DATE _� BUILDING PERMIT ISSUED ---------------•-•-- --- ----------------•--•-....................__..--.._. -•-----------.-------DATE _--- ...... ADDITIONALCOMMENTS ---------------------------•--------------------- -------------------------- ----------------- ---------------- •---------------- -- •------ ------ --- - •------- ------------------------------------•-----••----- --------------------------------- ......................... r' - - ------- ---- --- -------------------- ------------------ -a- - : ...... final Inspection by: . --- •... .......... . .... -------------------------------- 8/7h 3M. 4