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FOR OFFICE USE: U P S U — 7 Z IV 9 " APPLICATION FOR SANITATION PERMIT �- r� (Complete in Triplicate) Permit No. -7-2,-:-7-0.3 �:Cry - ------------------------ --------------- ---------------- --------------------------------------- This Permit Expires 1 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 .----------- -<---�--{ - �-, /��'l�L_4__Ilz----------------------------- --- ----CENSUS TRACT -------------------------- Owner's Name --------------- -- ----- --, ��rt�(!L ---�------------- - �� -------------------------------- --- Phone �- Address / _;w��4[��P-T�G- City ------------ Contractor's Name ---------------- --- I.-Cw----------License # ------------------------ Phone ------------------------------ Installation will serve: Residence N6 Apartment House Coommercial ❑Trailer Court I❑ Motel ❑Other _� _�Y7 -.._____ Number of living units:---- ----- Number of bedrooms _____Garbage Grinder --__---_-- - Lot Size 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 ❑ 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.) �p NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) / ^r - �PACKAGE TREATMENT SEPTIC TANKSi e__ - - -- - -- - Liquid Depth ----------------- _4& ----------- --------- MaterialNo. Compartments ........... Caacit ` Type Distance to nearest: Well __________ _r?'_-----------Foundation ----/CA9------------ Prop. Line t'__.__._ LEACHING LINE No. of Lines / f --_----�--------------- Length of//��eachpp}}line_----r[_��_._-_.___--- Total Length _1�.__.__.____-__-- D' Sox ____________ Type Filter Material _/S(1Tt.____Depth Filter Material ------`_ __ _______________________ !")-- r Distance to nearest: Well ______�f2 __ ___ Foundation ______/ ----- Property Line __ _. 7......... SEEPAGE PIT Depth -2 .________ Diameter 33_"______ Number ----------!---------------- Rock Filled Yes X No ❑ Water Table Depth ------------------------------------------------Rock Size /y_----------- f I Distance to nearest: Well _______f 0_P_ ______________Foundation _ -_ ------ Prop. Line _. `•_--- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) Septic Tank {Specify Requirements) ----------------------------------------------------------------------------- Disposal Field (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------------------- ------------- ------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------- ---------- ---------------- - ------------------------------ -- ------- -------------------------------- - -- - - - - - --- --------------------------------------------- (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 Loral 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, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed --------------------- Owner BY '----- s - ----------- ------- T - -itle ' - - - -------------------------------------------- (If of r than owner) _ FOR ARTMENT USE ONLY APPLICATION ACCEPTED BY ______ ____ ------------------------------------ DATE ___ :.__ _ _ BUILDING PERMIT ISSUED ----- -- ---- -- --- -- - - - -------- ------------------ -------DATE ------------- ----------------------------.. DDITIONAL COMME -------------=-------------------------- -- . ---- ---- --- ;----------- -------------------------------------------------------------------- --------------- -- -- -------------------- -- - ------ -- -------- ---------------------------------------------------------------- --------------------------- ---------------------------- Final Inspection by: ------ /-------------- --------------------------------------------------------Date -- SJOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M