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FOR OFFICE USE: pppLICATION FOR SANITATION PERMIT -7 Permit No. _ {complete in Triplicate] = �-► - Date Issued This Permit Expires 1 Year From Date issued - - -------------- -------------------:---------J----- cal Health District for a permit to construct and install the work herein Application is hereby made to the San Joaquin Lo described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: �� -I 1 - CENSUS TRACT --- . - /' -- ,_. , --------- f a JOB ADDRESS/LOCATION ._a - --------- -_-_--phone ��"�------��-- � Owner's Name - City, tx� ---- -- Address , M� � — -- J ----- - -1 ------ License # � Phone _ f s ` 2- _1---- --------------------------=----- Contractor'eName �%a"•` r if Residence ❑ Apartment House(] Commercial ❑Trailer Court Installation will serve: - of living unrts:_.:c: Mo#el ❑Other ----------------- ---- Garbo e Grinder ___-------- Lot Size Number g 1-_____ Number of bedrooms --- -------- g Private,® p ---------------------------------------------------------- Water Supply: Public System and name -_---- --- Sand Loam ❑ Clay Loam ❑ Character of soil to a depth of 3 feet: Sand' Silt❑ Clay ❑ Peat❑ Y P ..,; -t Fill Material -_______--__ If yes,t 3� Hardpan E] Adobe'❑ Yp ---------------------- ---- laced on reverse side.) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be. p d NEW INSTALLATION: (No septi+ tank or seepage pit permitted if public sewer is available within 200 feet,) F PACKAGE TREATMENT [ ]` SEPTIC TANK:[ Size_ Liquid Depth --------------------. VS i Cd`pacitY TYPe.----- ------ ----- Material----------------- --- N Compartments -------------------•-- Foundation ------- ---- - - Prop. Line ------•--------------- Distance to nearest: Well -------------- Total Length .--------- ---------- - LEACHING LINE [ l . `. of Lines -------------- ----------------- Length each line___------------ __Depth Filter aterial ---------------------------- --------------- Do Box _ ------ --- Type Filter Material ----------------- 1 Foundation ------------ - Property Line ---------------•--•-•--- stance'Jo nearest: Well ----------------- No SEEPAGE PIT [ j Depth --------------- Diameter ------ ----- Number ----------------- ---------- Rock Filled Yes ❑ Water Table Depth ----------------------- -------- Rock Size --- ---------- ----- Di�stancelto nearest: Well -------------- ----------------- Foundation ------ ----- ------- Prop. Line _. " 1 Date ---------- ----------------------- REPAIR/ADDITION(Prev. Sanitation Perm-t# ------- ---- ---- --------------- - - = I ----------------------- I ---------- - -------- Septic --- Se tic Tank (Specify Requirements) ------------------ ---- - yRequirements) ----------------------- ------------- ------ ------ --- -- --- -- -- --- ------ ------ ----------------------------- --- ------ ---- Dis os Field (SPecif - ------ � /j- ----�,r�ae7 _ q = ------------------ ------------ - ------------------------- --=----------_ _- . -_ �• ----�-,-� (Draw existingand required ad'----- ----- ------ ------ ------------ --- '�` l --------- addition on reverse side, --------- ----- lication and that the work will be done in accordance with San Joaquin I hereby certify that I have prepared this application County Ordinances, State Laws,' and Rules and Regulations of the Son Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: arson in such manner "I certify that in the performance of the work for which this permit is issued, I shall not employ any p j as to become subject to Workman's Compensation laws of California." s Owner -------------------------- 5igned --- ----- --- { _ Title - ------- ---- -- --- ------ ------- ------ ------ ----- - ----- Y - ---- - ner) ------- - --- (if other than owFOR DEPARTMENT USE ONLY 3F DATE �= ' --/�'1----------- ( ----------- ------------------------------------- -- ----------- DATE --- =--------------- APPLICATION ACCEPTED BY - _ ._�- - -- ---- i BUILDING PERMIT ISSUED - ---------- ---------------------------- -------------------------------------- ADDITIONAL ---------- -- ----------------------- ADDITIONAL COMMENTS -- -- - --- -------------------- ------------------------------- -- ' -- -- - - r ._ Date '----- Final �- � inspection y: ---- �'. SAN-JOAQUIN LOCAL HEALTH DISTRICT t F- H_ 9 1-'6& Rev. 5M