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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT b Z Permit No. 7�—•.�--•-••• ................................._.,.... ".._.. (Complete In Triplicate) _ . �'�_.d.... Date Issued .��...�:`r.73 ....... . ...................••---- - _.f... This Permit Expires 1 Year From Date Issued work herein Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the de tribed. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: .CENSUS TRACE JOB ADDRESS/LOC ION. ... ..l.p- . _..........:-...... .. ........Phone .• Owner's Name ......_ ........... .._..._. .__ City Address _ .... 'cense-# .. �_ , ..�. Phone F Contractor's Name .._'_.. -- -------• ---- Installation will serve: Residence JeApartment House Commercial ❑Trailer Court 0 t � (J\.` _ M R Motel ❑Other ------ �---ma`t •------ ---•-- • y•-- --- Number of living units------ ..---- Number of bedrooms- _ff •-Garbage Grinder .1-_.---_---- tot Size ...:_ -. ................ Number _...Private EU I Water 5upply:. y ..._.....--- IPublic System and�name __..s__-__._:_---._•-------- Character of soil to a depth of 3 feet: Sarid❑ Silt❑ Clay ❑ Peat❑ Sa`nciy Loam {] Clay Loom y. type [� . '_Hardpan ❑ Adobe '0 Fill Material .:........... f es, a .------• �'. buildings, etc. must be placed an reverse slde.l (Plot plan, showing,-size of lot, location of. system in relation to wells, _ NEW INSTALLATION: (No septic #ank_orlseepage pit permitted if public sewer is available within 200 feet,) SEPTIC TANK t ] Liquid Depth .....__....•.......•..•--- PACKAGE TRE=ATMENT [ ] --------------- ----------------- Material.----- I... . No. Compartments -- _--..:= ...... Capacity ............... Type - ' F .. Pro Line ......... I Distance to nearest• Well T ......-Foundation ..... .............. P I _ I ...... .... Length of each line..-------- .._. .__ Total Length ..... ............... LEACHING LINE P9- No. of Lines _._.__.. ___. • ` ' Depth Filter Materia! ... �.._ 'D' Sax Type Filter Material p _- pisfance to nearest. Well .........;?' _". ,• Founddtion ..... �.�......._. Property Line.... ---._...:.: .. "Of Number ....._..._/....._.... _. Rock Filled Yes � No C Det �. • Diameter . - • - , i SEEPAGE PIT �Q Dept' ----- _ Water Table Depth _- ............... : -...Rock Size • a--:............ ..... r Pro Line .._ --•-- i Foundation ../-1 ._.... p. Distance to nearest: Well ....�� --- ---------------•••----,--�,-• .- I ate ................................. REPAI ADDITION' rev. Sanitation Permit .-.-• ........ ' Septic Tank (Specify Requirements) . ........-1.1------................•...........w............................. - .. Disposal Field,(Specify Requirements) --:..- -- --- :_ -_ I -----------------------------------------------------------.-------- I ... -------- --•- ............. ... - .... (Draw existing and required addition on reverse si d ej I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State:taws, and Rules and Regulations of_the•San Joaquin local Health District. Hoene owner or licett- sed agents signature certifies the following: person in such manner °'I certify that in the performance of the work for which this permit is issued, I shall not employ any p as to become subject to Workman's Compensation laws of California." , Signed --....----• -•--- — . Owner /I 3 .............. .... xitle ---•(lf other than owner)x FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .......... " •-_. DATE .. .� -5. ---.._----- . ... .. ... ... ...•---... .. -•--•• DATE .......... BUILDING PERMIT ISSUED .. ..............••••- ADDITIONAL COMMENTS ---••--------•..............."---............. 1. _...... •--- .......... ..`.. ..... . - . - .-.... - Date .....h ._. ..._. ' Final inspection by: � �...��:��1 �••-:-•-.=----�......_.__......_.�.---- _ i �� OAQ77 UIN°'LOCAL WEALTH DISTRICT" SAN J - *� �_— - 7/723 .K. c ��