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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ,/ 37 (Complete in Triplicate) Permit No: .7`�-=_'�.___- --------------------------------------------------------- 7 ________________________________________________ This Permit Expires 1 Year From Date Issued Date Issued _-_ Y _ I/ 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 .____ 'Z__ -�� K�------------- �+�_�_-__._-_CENSUS TRACT --------------- ---------- Owner's Name ----------- W_ -------- -------------- ------------------------------------------_Phone Address ------------------ -- ------ - Z.- F - -- ------------------------------- City --------------------------- --------------------------------------•---•-- Contractor's Name ....... -`-------------------------- --------License #XZ------ Phone ------------...-.............. Installation will serve: Resida [ artment House❑ Commercial ❑Trailer Court 0 t ff Motel Other ------------------------------------------ o {6e3 Number of living units:-----I --- Numbef fdraorns Garb❑ �g t Water Supply: Public System and nari�e ------�_ ------------------------------------------------------------------------Private ❑ Character of soil to a depth of 3 feet. Sand ❑ SilClay E] Peat E] Sandy Loam ❑ Clay Loam ;❑ ' \HaPdpank\AZbe ,E] Fill Material ____________ If yes, type ____________________________ (Plot plan, showing size of lot, loco i:or�of syst in relation to wells, buildings, .etc. must be placed on reverse side.) NEW 1N9LA1R16N _ (Nom epic tanker seeps ,t permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT I ] SEPTIC TAN K'[� Size________________________________________________ Liquid Depth ____-_-_-___---_--_--_-_- Capacity ..__ Type _ ___ _______ Material_ No. Compartments tanceto nearest: ell ____ _Q_�_______________________Foundation --------- ------------ --------- Prop. Line --�-------_--•----- r LEACHING LIN. c .-- 7 ---------------- Total Length ------1 ( `--------- o�of Lines _____._� _ ____ Le gtFt of a ch fine____ __ g ' Box -_ TypeFilter Mate`rialDepth Filter Material �- --------------------------- 11D. m rl Distance to nearest: Well kms____ _________ Foundat•ion� ............ Line 0-0-___-_--__---___ i SEEPAGE PIT [ Depth ___ --------- Diameter � 9'0 _ __ Nu 1 ,••_� ber _2— _ __ _ Rock Filled Yes ET- No0Water Table Depth -------- 4- --------------��Rocklze _N------------------ ---------- Distance tb nearest: Well __ *___ ___Foundatioh- _-fpr-__-_______ Prop. Line ....................... REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------------- - -------- Date ---------f------------------ )` SepticTank (Specify Requirements) ---------------------------------------------------------,----_-------------------•----- ------- -----•-------,..----•----=-A--•------------ Disposal Field (Specify Requirements) ______________ _ �r� -------------------------------------------------------------- --------- ----------- -'l�� --------------•--------- ------------------------ ---------------------------------------- (Drawexisting and required addition on reverse side) L__—_—j 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 becomp su je to War n's CamUenti.gn laws of California." l Signed. i _=' - - - __--�-= Owner ��.,. --------------------- BY -------------------------------------- ------------- --------- ---- -------------------------- - (If other than owner) O D PARTMENT USE ONLY APPLICATION ............ACCEPTED BY ----- --------------------------------------------------- DATE .... 7----- BUILDING PERMIT' ISSUED --------------------------------------------------------- --------------------------------DATE L ------------------------------ ADDITIONALCOMMENTS ------------------------------------------------------------------------------------- ---- ----------------- ------------------------------ --- _ _ -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------ . ---- ----- ----------------------------'K = �_ p� --- =------- .. Final Inspection bY:' --=' -----G. --- ---S20-----------------------------------------------------------Date �r r SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev.-.SM.