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tfOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ........ ............................... ........ � Permit No.7��:...._......... �• (Complete in triplicate) This Permit Expires I 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: JOB ADDRESS LOCATION / .........CE SUS .. - . �� N TRACT Owner's Nome ..11, 'r.� e � a . J........ .... ........ ........... ..........................Phone , Address _.gy� .V••-,4'.--•-- --- -••-- =_ c ------ ........ City ...�J t..... ...........-......... Contractor's Name nse-#-v�:�r_4��.! `15�.Phone .... 3.2.-.9)Tb � .. I .; .Hce_ Installation will serve: wBence A artment Ho_use Commercial Trailer Court C],!' , «, Motel ❑Other ' Number of living units:..-. .... Number of bedrooms ....Garbage Grinder ------- Lot Size ....-- - , .�.._.......� Water Supply: Public System and'nome .............. . . .._.Private -•----------------------------------------- -------- Character of soil to a depth of 3:feet: Sand r] 'Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ [ Hardpan E) Adobe ❑ )Fill Material -------------If yes, type .......-_-----.------------- (Plot plan, showing'sizei. lot, location-of system in relation to wells, bdings, etc, must be placed on reverse side.) + NEW INSTALLATION: (No septic tank or seepage pit permitted if publie'sewer is available within 200 feet,) � PACKAGE TREATMENT [ ] SEPTIC TANK t j Size..............f.........--�; ........ Liquid Depth ..........._--.._--------- W Capacity AO.� ...... Type ..f'' -Matetial.. No. Compartments _._ . ar _ . Distance to nearest. Well ........�/ -o_._._...._.------.-_.F.oundation ....: ......_. Prop. Line ...J............ r ? LEACHING LINE [ ] No. of lines ..... .................. length of each line. ............... Total Length ...., ........_. I 'D` Box __ s -.. Type Filter Material ......tY. ....Depth Filter Material ......1.LF............................. y Distance to nearest: Well .A..O........... Foundation ......... Property Line 3 ........... SEEPAGE PITi [ ] Depth Diameter ................ Number ............................ Rock Filled Yes ❑ No 0 Water Table Depth ................................... Z.L.-Rock Size Distance to nearest: Well ......................:.................Foundation Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit ........ --.--_-- ------ Date ..................................) ' SepticTank (Specify Requirements) ....__...........-- - e':.:....... ...................................•--•---................_...I._.._.. •-•------------........_..... t I DisposalField (Specify Requirements) ------------------------------------------------ -••....................................................•------_------------------- •n -------------- -----)....- ------------------------------- ----------•------..--...--•-•----------------------------------•-- ...... ................ ..........•...................... (Drow'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 Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or liven--+ sed agents signature certifies the following: "I certify shat 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," , Signed ......_.. ---------... . Owner y� ------------ By .._ ...................................... ................. (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .. ..... . .............................•__-...................................................... DATE ..........+a? ': .._•..... BUILDING PERMIT ISSUED . ...... ......... ....DATE ........................................... -- ADDITIONAL COMMENTS = .........................I....... ... :_................ -• --__ ......__... Final Inspection by: ••-•--•-----.Date ....... ...:..... .--... ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT i 7179 3 M