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c FOR OFFICE USE: `, ..fi APPLICATIO-FOR SANITATION PERMIT f " Permit No. -7�+�U.1'.-. (Completein-Triplicate) -----------------------:---------_--..- This Permit Expires 1 Year From Date Issued Date Issued ._.................. oiJ: 2_07^d�)—O 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: T3U OB ADDRECL oN ---- - -- �- 1. p �F � C, -'Cer �e►u ------------------------------------CENSUS TRACT .SA......-------- Owner's Name -------------------------------- ---------•-•----•• ..........-.......................................Phone --- _:Zaagb(i............. Address .... '�j�Ob__.. ..'.. ouch Ci d`................ city ........- i Contractor's Name pc�P-C--N 2. 10_ ,i--- y- )-•--...--- -.License # ----•-••-:-•--•--------- Phone --------------------•---_----- Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Court fl Motel)K�Other S 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❑ 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 within400 feet,) PACKAGE TREATMENT SEPTIC TANK Size..................................... { 7 i � ---•----.._ Liquid .Depth ........................... Capacity --------------------- Type ------ Material_------------------- No.—Compartments ...................... � P�?< Distance to nearest:. Well ..............................Foundation ...................... Prop. Line ...................... LEACHING LINE [ J No. of Lines ________________________ Length of each line----------------------------- Total Length ....__.. ................... 'D' Box ------------ Type Filter Material _________________--Depth Filter Material ..__-.__.___---_ ...................... Distance to nearest: Well _______._______..__.._- Foundation ------------------------ Property Line ........................ SEEPAGE PIT [ ] Depth --------------------- Diameter ----- ....._._ . Number -----------............----- Rock Filled Yes ❑ No'1❑ Water Table Depth -------------- ------ -----------------------•--Rock Size ................................ Distance to nearest: Well ........................................Foundation .................... Prop. Line ..................... REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date _.__-_____._______________._______) Septic Tank (Specify Requirements) -------- .....................•... ................... Disposal Field (Specify Requirements) -__ .-_-__�QQ� ---------------•-----------•--- -•---- ---------- ---- ------------................................................................................................. ----------- ------------------ .---•----------•---------------------------------------------------------------------------•-- ------......- ----------- --------•---------------------•----_.._...--•---•............._.......-- (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 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." Sign - ---------- Owner By x�_ . .1_�_ G'l.✓.................................................. ..•••-- --- Title ....................................................... - ------------ (If otOfhan owner) FOR .DEPARTMENT USE ONLY p APPLICATION ACCEPTED BY --- - ---••-•--•------------------- ----------- ------- DATE _-.'1'.��-.70. --•--------------- BUILDINGPERMIT ISSUED ---------•------._...__......._...I--•------ --------------•---•---------•---- .-------DATE -- ------ ------ ...................... ADDITIONAL-----------------------C--O- OMMENTS ------------- ----------------------- -----------------------------••--- ----------------...------- ---------------------------.--a....._......---- ..---.-- ...._ ----------- ------------------------------------------ -•--------------------------------------------- ----------------------•---•------------•-------•--------------------•-•----------- -•-- ----- ........................... �-- - Final Inspection by: ......................•--.•.. --------------------- Date ............. ----- --- SAN JOAQUIN LOCAL HEALTH DISTRICT