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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 3 A Y�6 ----- -- ---- ------------- ------ Permit No. --7 -------- ----------------------------------------------- (Complete in Triplicate) t -------------- 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 described. This application is made in compliance with �C�ounty Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION -----7-7-0 2------ ------�/_�l,1_r�QD-1</1,ARD_----------------------CENSUS TRACT __��_ _7 ------- Owner's Name ----------�1"_R�a-Lj)--- / ----------------------------------------------------------Phone __ 3_"_ ..�-_ Address _ZC3t__..y._S'1 IR"I , -------------------------------------------- Cit Contractor's NameE 1 11111 ---------------------- -----------------------------------.License # Phone Installation will serve: Residence ❑ Apartment House[],Commercial ❑Trailer Court ;❑ Motel ❑ Other -------------- ---- -- a:l Number of living units:_._______ Number of bedrooms�______Garbage�rinder .� Lot Size. ____________________________________________ w . 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 ❑ Adobe ❑ 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,} l PACKAGE TREATMENT { ] SEPTIC TANK;H' Size-_�__��42----X___..a `_�Y_ Liquid Depth ------��---- O Capacity /_7 I---- Type*E_(45l__; Material % __._ Nor Compartments ----2, Distance to nearest: Well ____1.5-0___" "--------------Foundation ______ Prop. Line __.. _.. ...... LEACHING LINE /] No. of Lines ____3-------------- Length of Each line----e7 Total Length ...... D' Box/Ve�j._ Type Filter Material 0 __Depth Filter Material ----- �__-`____________________________ d Distance to nearest: Well --------- ------------ foundation ______________________ Property Line __________________-_-___ SEEPAGE PIT [ ] Depth ______ Diameter _-- -___ _ Number ____________________________ Rock Filled Yes ❑ No [ Water Table Depth `' -.------ ;-- ----- ='---'-=- =-=�Rotk Size ----------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ______. ________________________________ Date ---------------------------------- Septic -_____- ______________________Se tic Tank (Specify Requirements) -------------------- } - r------------------------------------- -----------------------------•--------------------------- Disposal Field (Specify Requirements) ------------------------------------1------------------------------------------------------------------------------------------------ I €------ �------------------------------------- -------------------------------------- --------------------------- v , 141 --- -------------------------------------------------- ------------------ ------ r------------------ ---------------------- (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 Jhat in the performance of the work for which this permit is issued, J shall not employ any person in such manner as to becomesubjectto Workman's Compensation'laws of California." a Signed �:�/-__ �""--------------------------------------------------------------- Owner BY -------- ----------------------------------------- --------------------------------- ----------- -- Title -------- - -------- - - ----------------------------=-------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ----------------------------------------------- -------------------------------- DATE _.��--------- BUILDINGPERMIT ISSUED -------------------- ---------------------------------------------------------------------------- -------DATE ------- ----- ----------------------------- ADDITIONAL._COMMENTS-.._r_"r.------- --.:-- .:,.-------------------------------- .nz,.....,.-._:---,� ---,------.-__ �z-- ------------------ :----_- ------ ---- _ -- - ------------------------------------------------------------------- ---- - - ---- - --- - - -- -- ----- --------- - - - - 1 1" f Final Inspection �_ ---------- -- - -- - -- ------Date 4 ! r SAN JOAQUIN LOCALJgEALTH DISTRICT E. H. 9 1-'b$ Rev. 5M