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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -7 (Complete in Tripltcotel Permit Na. .. /7j .....-...... . .-••.................................................... This Permit Expires I Year From Date Issued Ddte Issued ..v _�� 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 wit County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRf5SjLOCATIO �i i'?- '1! ...... a �...,.................. ............,.......CENSUS TRACT Owner's Name .. �� Address :.�.� .. �....� ................Phone ......... .......................... JQ. City .................................. Contractor's Name . . . .. ... ...... .......•---:..---.License # .If3 .��Phon - �'-- a ...--•........................ Installation will serve: Residence❑Apartment House ID Commercial ❑Traller Court ] Motel ["Other - _ Number of living 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❑. Slit 0 Clay [J Peat❑ Sandy Loam Clay Loam O Hardpan.[]- Adobe 0 . 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 tante or seep ge pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ } SEPTIC TAMC Size .. ` .. f.....:.. Liquid. Depth ` ....�............... Capacity Type • -•- Material... 'G � --No. Compartments r Distance.to nearest: Well A_ / •-------�.......�...............Foundation ...C.r:?..�........ Prop. Line ACHING LINE ( No. of Lines -----•-/-.---•-- Len th of each line.....�:a Total Length ..-........ 'D' Box .. Type Filter Material ...... -1'�-------Depth .Filter Material Distance to nearest: Well ----- Foundation , ....f..(?./.�.r---. Property Line ..A_._... ........ SEEPAGE PIT [ I Depth -----I.............. Diameter ----------=----- Number ............................ Rock Filled Yes ❑ No C1 Water Table Depth ----------.................-•---------..........Rock Size ................................ Distance to nearest: Well ................... ...... ----................ Prop. Line .......................lt� REPAIR/ADDlTlON IPrev. Sanitation Permit# ................................-------------Date .................................. Septic Tank (Specify Requirements) ...:........................ Disposal Field (Specify Requirements) ...................... ---------------.- ................•-----...---------•......:.------------*................................................................ (Draw existing and requiied 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 Been sed agents signature certifies the fallowing: "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 l By .... --.--- 2 Title {ff other than owner �f i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTS© BY ._. _----- -------------- ------ -- DATE BUILDING PERMIT ISSUED : .... ----- A ---------------.......................................DATE ........ ADDITIONAL COMMENTS --- ----------•-•---•-•-- --- .....__.. .................. ... ----- ------- ---------------------------------------- --=----------•--------......................- ----------------. ---------- --------.......... -........-.------ ------------------------------ - Final Inspection b - - p Y ........... .............Date _... ._.:•.:......----..:.,--------_....-- EH 13 Zia 1-•683 bear. 5qt SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M