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-FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -----------------•--....-..--------_----•-------------•-- Permit No. .7 •�a Z (CompleteinTriplicate) 7J� ................................... --•••- Date issued .................... --- This Permit Expires 1 Year From Deft 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 ........ ,6,35/ _ ./7 . . ......................CENSUS TRACT ...-..........---......... f Owner's Name .... !7 • .................. ..................:_...--..........Phone -r��•.'.. ......._..._.._.- i ... ,p �8 Address .-••----_.... Cj�cx''''u` ... ity ...d... Contractor's Name _.. License # +1 ••••• Phone .. Installation will serve: Resi once❑Apartment House0 Commercial []Trailer Court 0 ' Motel E]Other ......�`.��le�.- dumber of living units:----____.-_ Number of bedrooms Garbage Grinder Lot Size _..-•...................... =•--••••- Water Supply: Public System and,nome .........Private 91 Character of soil to a depth of 3 feet: Sand 10 Silt[IClay ❑ Peat Q Sandy Loam fl Clay Loam ❑ I # Hardpan p Adobe[] Fill Malarial .... if yes,type..... , (Plot plan, showing size of lot, location of system 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,) -� PACKAGE TREATMENT [ J PTl�.C TANK I ] 5ize__._.f}.`_✓ `-q__`..-.._-.•••................ Liquid Depth ...`?�`...........-...... Capacity � SE X00 9!Vf Type eAC--1 • Material.....P-�..??�_`...... No. Compartments ...!t...............%P• Distant d0 ' ----_-___Foundation 1 A.'_.._..._ Pro Line of a to nearest. Well �------------------ ---- • -- P• ......---.......::...� r - LEACHING LINE { j No. of Lines .-.... ............. Length of each line............................ Total Length ...�.°0...............• �, ., r 'D' Box __.I--_.... Type filter Material ..� .......Depth .Filter Material ..................I........... __.........� Distance to nearest: Well ..y./!�®........... Foundation ...t6.`.............. Property Line ............. - I SEEPAGE PIT [ ) Depth -------------------- Diameter _--------------- Number ............................ Rock Filled Yes ❑ No. .........................................Rock Size ------...... ................... O� Water Table Depth .............. Distance,to nearest. Well ...Foundation ..... .............. Prop. Line ....................... REPAIR/ADDITION(Prev. Sanitation Permit# ..........•...... -------------------------- Date --------------------•-------------} 7 I Septic Tank ;Specify Requirements)................. . .. ------- ----......_....-••-- = _•--•...---------._..._.. ...................... A Disposal Field (Specify Requirements) --------- ----- .................. ------ - ------------ •••--••--- -1 = (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 s County Ordinances, State Laws,!and Rules and Regulations of the San Joaquin Local Health:Dlstdct. Honte 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 Com ensation laws of California. Signed ...... e _fig' f ... Owner By ---------- -------•----------- - ----- Jitle (If other t ) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _............. ......... ----------- � � .. ------ BUILDING PERMIT ISSUED ----...It------------------------------- ------------------------------------ -t. - -DATE --......... - -•-_----- ADDITIONALCOMMENTS --- -------------------------- _....----.... .......... ....... ..•--•-•---- ....................... ------- ------ ----= ---- _............... .. •• --------------- ....... ... ---- -----------------• - . _..Dale ... ..a..9 .. final Inspection b i.._ �.. ---------------------------------- EH •-------------•-•---•- ---- -- - EH 13 2h 1-6 Rev. 51 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M