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_..� vrriCx U5e: J____ APPLICATION FOR SANITATION PERMIT 1 .............. (Complete in Triplicate) Permit No. ..7..6. ��... - �._ This Permit Expires 1 Year From Date Issued Date Issued .. �. Application is hereby made to the San Joaquin local Health District for a permit consirtianddescribed. This application is made in compliance with County Ordinance No. 5490and existing Rulestalndthe Regwork h ulptionarein i JOB ADDRESS/LOCATION .-. ,, . ... ........... ..... ...... CENSUS TRACT ...,. Owner's Name Addre .......................Phone ......... ....... ss ... . . ......... . Contractor's Name ---- //................................. ....••....... .. . ,, license Phone J �/! ................... Pho C❑ P Installation will serve: r •• -- ..<.. . esidence A� artme Housed Gommercia) ❑Trailer Court Motel ❑Other.. Number of living units:......_..... Number of bedrooms .4.-_-...Garbo a Grinder ............ I P 9 Lot Size Water Su ..... t ••• "} pP y: Public System and name ........._ -----.,.........:......❑ y oam ❑ Clay lcamrl Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt[� Clay �� ❑ Peat Sand ! Hardpan[`] p Adobe L7 Fill Material ............If yes,type {Plot pian, showing size of lot, location of system in relation to wells, buildings, e NEW INSTALLATION: tc, must be placed on reverse side.l {No septic tank or seepage pit ,permitted if public sewer is available within 200 feet) PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size..................... ............._........_ liquid Depth ........................... Capacity ---: ........... ..... TYP Material..... I e ...------•--•----•- ........ No. Compartments Distance.to nearest: ""'••"'-""'•••-•--1� Well ---------------------------_- ----Foundation ...................._. Prop. Line . LEACHING LINE [ No. of Lines .........�/ + --------------- Length of each line._.. ................. Total Length ...... I 'D' Box -_-. Type Filter Material _.:.... -.......Depth .Filter Material •..........•.. Distance to'nearest: Well ........................ Foundation SEEPAGE PIT [ j Depth ? ............. Property line ........................ -- •.�,... p -X•!�-.�IPthometer :-----...- Number -------- •............... 'Rock Filled Yes No:❑ Water Table Depth -••-------•=-...... ............... Rock Size .... .. , ................ Distance to nearest: Well _....__.__.•-•-----••--------------- --Foundation REPAIR ......... ....... Prop. Line ... /ADDITION(Prev.(PreySanitation 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 Lawsi and: Rules and Regulations of the San Joaquin Local Heallh.ofstricf. Homs owner pr filen- , sod agents signature certifies the folio' ' ! "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 became subject to Workman's Compensation laws of California." Signed r ------ -------------------- Owner Y •- - - ----- -- -----------` Jitle _:. --.... (if other than owner] -•............. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- - BUILDING PERMIT ISSUED ._. ..--- ----_#- ADDITIONAL COMMENTS ..... ......... - -- ------- ------------•--.._..DATE ---•��------�-------............----.._.�.. -----•-•-•---•-... -- ---------- ----- ------------- ----•------ ................. ---------I............... ------ ---••---._.. -_. Final In 1 spection by: .. EH 13 2 ----------------•-------•------------- ....- '.... -6f3 Rev. )]ate ��- 9 ............::..: SAN JOAQUIN LOCAL HEALTH- DISTRICT B/?h 3M a