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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT � ------------ -------------------- Permit No. 7 7--�� ------------ [ComF�lete in Triplicate) •- --------- This Permit Expires i Year From Date Issued Date Issued _ - Z-_.7/ 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 .-- ------ -------- ------- � 1`"- - -�------------------CENSUS TRACT -------------------------- Owner's Name ._.__ g L _ -� Phone -- ----- Address --------------------- - - -- -- /If�-- City e- -- -------•------ Contractor's Name ----------- _ -tied---- License # -�` - - Phone . _ _3. . Installation will serve: Residence XApartment House❑ Commercial :[]Trailer Court i❑ Motel ❑Other -------------------------------------------- Number of living units:----/ Number of bedrooms __�Z____Garbage Grinder ---.-6-- Lot Size -------------- Water -_0 - Water Supply: Public System and name ------------- 1e4 ------JVA ----f---------------------------•---------------Private El Character of soil to a depth of 3 feet: Sand'Q Silt❑ Gay E] Peat E] d Sandy Loi❑' Clay`Loam :❑" Hardpan ❑ Adobe.A� 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT { ] SEPTIC TANK'[ �� 7"f Sze_________________________ q p ---------------------- Liquid Depth -------------------------- 00 Capacity .----- - Type -------------------- Material---------- ----------- No. Compartments ---------------------- Distance to nearest: Well _________ _______________________Foundation ---------------------- Prop. Line ------ ______ r LEACHING LINE No. of Lines ----/--------------- Length of each line-------- __ Total Length ____ ____- 'D' Box --- Type Filter Material _A'__(;_!tDepth Filter Material ___ _____ _______•----_-_--____-- Distance to nearest: Well J -�__________ Foundation ---A©----__--- --- Property Line SEEPAGE PIT [y Depth __ $T...... Diameter ------J---- Number ___________ -------------- Rock Filled Yes E�r No i❑ � rf � f Water Table Depth ------ -----------------------------------Rock Size Distance to nearest: Well ------,--------------------------------7Foundation -------- Prop. Line ___47�.......... � REPAIR/ADDITION(Prev. Sanitation Permit T# -•-----•------------------------------------ Date --------------------..------ -_--) Septic Tank (Specify Requirements) ------------------------------- ----------------------------------------------------•---------------------- ; Disposal Field (Specify Requirements) --- _ L Y`!v 6--------S-e-P------ -...A e=�`f-- e i v e - - /�� rg cA° ! � ----- ?w� IV-4z------�-'----�--------`----�X-J_-;? ------------- ---------- e� N -- -------� ..........O/= (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 Local 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 -- --- ------- - ----� - ----------------- ------i�-" / ----------: Title --------------------------------' t-------- -- - - ------ (if other than owner) FOR TMENT USE ONLY APPLICATION ACCEPTED B --- / = -------------------------------------------- DATE // ,7-/--- BUILDINGPERMIT ISSUED -- ------------------------------- -----------------------------------------------------------------------DATE _41-------------------------------------- ADDITIONALCOMMENTS ----------------------------------------------------------------------------- ----------------------------------------------- ------ ----------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------ ----------•--•---- --------------------------------- ------- ----- ------------- --- ---- -----------------------------•--------------- --------------- - ----- ----------------------------- ------ ^� Final Inspection by: -- _-- ____-- Date --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M