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rt FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No: (Complete in Triplicate) ---------=---------------------- ----------------- - 7 --L Date Issued __'____----- --- -- ---------------------------------- ------------------- This Permit Expires 1 Year From Date Issued E 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. 544 and existing Rules and Regulations: - w :.. -- - --------------------------------------�-'f2-r�3o r.31 7.�.� q1.. D-r[.,J7�4rrJ cJr CENSUS TRACT . �OS ADDRESS/LOCATION ----- � ltecu Owner's Name. - ---- ----- - � 1�1�/�------------------------------------------------------- ------ -------Phones ca`� -- - Address - 1 '"_ Cit Y Contractor's Name ----------------------- - _ -------------- -------.License ----- Phone ----------------------••------ Installation will serve: Residence[5-Apartment-House❑ Commercial !]Trailer Court i❑ Motel ❑Other --------------------------------- ---------- Number of living units:------t----- Number of bedrooms -3-------Garbage Grinder �?--.-- Lot Size _---___9n-=----------------------•---- Water Supply:lPublic System and name --------------------- --------------------------------------- ---------------------------------------- Private.[ Character of soil to a depth of 3 feet. Sand'0 ' Silt❑ Clay E] Peat ElSandy Loam ❑ Clay Loam ❑ i Hardpan ❑ dobe 'l(l Fill Material ------------ If yes, type ____________________________ (Plot plan, showing size of lot, location of syst m 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,) c e ti PACKAGE TREATMENT [ ] SEPTIC TANK Q µ Size------ -------------------- --------- Liquid Depth ---------------------- Capacity -----.--- -----------Capacity AOVUACW_Q __ Type Material tW -.__ No. Compartments ------ _.-Z,.____-:--_- ' Distance to nearest: Well ----------------------Founndation --_�----______ Prop. Line __- LEACHING LINE [ ] No. of Lines ------3-------------_ Length of each line-----q f-�-_-------.------ Total Length Q------•-•.•---- i 'D' Box Y_" Type Filter Material �? ' _ _4x,�_____Depth Filter Material -------L�u----------------------•----- Distance to nearest: Well ----- ____________ Foundation _________ Property Line_ ___ ____--.-_'_- SEEPAGE PIT [ ] 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) ------------- -----------...-------,.---------------------------- C Disposal Field iSpecify Requirements) ------- ---------------------------------------•--------------- ----------------- ------- --- -------------------------------------------------------------------------------------------------------------------------------------------------------------- -------- O (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. Home owner or licen- sed agents signature certifies the following: person in such manner "I certify that in the performance of the work for which this permit is issued, I shall not employ any y\1 as to become subject to Workman's_Compensation laws of California." Signed,_)- -------------------------------------- Owner -------------------------------------------- Title ---------------------------------------------------- ------------------- ' (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------------- DATE ----- =2s_ -------------- BUILDING PERMIT ISSUED ----- ------------------------ = ------------------ -- --- DATE ADDITIONAL COMMENTS ____----___------.-_- `� � ' � M.. ----- `------- ------------------------------------------------------------------- ----------------------- - ----------------------------------- --------------- ------ Final Inspection b ----------------------------------- - -- - ------Date -- "G71 --------------- SAN -------------SAN JOAQUIN LOCAL H TH DISTRICT C u 0 1_'AA Re-v 5M