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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT ...........:................................._._._._ Permit Na. .7�� (Complete in Triplicate) ...............I.............:: 4 _ 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 describer!. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulatlons: � // 'Fe ' JOB ADDRESSAOCATION .. ..- --l-...__....... .............. ..41 --'._.....................................CENSUS TRACT .......................... i Owner's Name -.-._. ..•• ............Phone ............................. i Address ... ........ a w-•---:. :.:.City c..° .........:n. - - Contractor's Name .......License # .�.t�� r.Z-Rhone ...... .----•--.......... Installation will serve: Residence Apartme�nt House❑ Commercial❑Traller Court 0 Motel ❑Other Number of 9 levity 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 j/' Adobe t3 Fill Material ....t....... If yes,type...........I... ............ f - (Plot plan, showing size"-of 'lot,lacati(in-of system_in' relation to weils,_buildIngs,•etc. `must be placed on reverse side.) C NEW INSTALLATION: (No septic tank or seep ge-.pIt.permitted If p blit sewer is available within 200 feet,! PACKAGE TREATMENT ( ] SEPTICTANK� _ �'..�.... Liquid Depth 7`..................:... Capacity V.._.._. Type __. ' tMoterial�?^- .....-- No. Compartments s ---...j.�..... Distance to nearest: Well ....__ -1,.9 P. ---- Prop. Line LEACHING LINE [ No. of Lines ---... __________--- Length of each line a ------- Total Length . .01• 'D' Box ---• ..... Type Filter Material .......S&- -.Depth Filter Material _.. ............. r Distance to nearest. Well .... _.Q. -. Foundation ---_ko.. ... Property Line ... �...`...f''•••• \ SEEPAGE PIT (A 1/1, Depth ...._.c�_ Diameter -=:�r_- Number __._... ............... Rock Filled Yes �No C1,. •j` r r, 4 Water Table Depth --- ... ...........Rock Size ... ._.._.. Distance to nearest: Well ..... _- ..4+.,..�. `............Foundation ._.. .C1 .. Prop. Line .._7 .. . REPAIR/ADDITION(Prev. Sanitation Permit+# ............................................ Date ...................................I SepticTank (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 Local HeaII&Dlstrid. Home owner or liven- sed agents signature certifies the following: "I certify that in the performance of the work far'which this permit is issued, 1 shall not employ any person in such manner j' as to become subject to W man's Compensation laws of California." Signed -.....--•... .............. .- ---------•• - Owner CBY ....-----•-------------------- Title '! ...-.. (if other than owner) FOR D PARTMENT USE ONLY APPLICATION ACCEPTED BY ----- = -- •--- ---- -------•-------------------------. --.............. DATE ...G�..1.1`.. .. .................... BUILDING PERMIT ISSUED ------------------------------- _... -----DATE ----- . ........-----.......---------- -- ADDITIONAL COMMENTS --------- . ............. -- ------ ------------ ----------------•---•-----------....................................................-...--------------------------------------...._..------------._........------.....- -- ------ . -• ---- --------- -- ------------------------ - ------------•-- Final inspection by *5m --•• --------•----------------_ ............ -------.------.....----•----._.. ......Date ... EH 13 24 1--6€i Rev. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M