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FOR OFFICE USE: 'pLICATIQN FOR SANITATION PER' y c� -••" Permit No. _7 / (Complete in Triplicate) --- - - _----. 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 HYD'., nce with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION __45.A .__ _. � ------- CENSUS TRACT __ .... Owner's Name ,-------- ice --- ,.��- ------ Phone .-- � - Address Cp �- .,�[� �'% ....... .... _ City .., /0 � ----- Contractor's Name _.. -- _-_ # 5-�i1%��Phone Installation will serve: R�dence Apartment House❑ Commercial ❑Trailer Court .❑ Motel ❑ Other -----------••---------------------------- Number of living units: tl 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❑ Clakaterial Peat❑ Sandy Loam ❑ Clay Loam E]Hardpan ❑ Adobe E] .... ___. If yes, type __......... --------------- (Plot ............_(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,) PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size.------____----------- - _-- . -_ . Liquid Depth -- 6 Capacity . _ _ _ Type . . . ............. Material. _ . . - _ No. Compartments ---------------------- O Distance to nearest: Well _. _-.._ ._..._.._ . __.._Foundation . __.. Prop. Line __________________ LEACHING LINE [ ) No. of Lines Length of egch line Total Length _____;1_16 � (S��j 'D' BoxCf�. Type Filter Material .��. - Depth Filter aerial _-,� .��...._._-___� Distance to nearest: Well - /06... . _. Foundation ..__�0..____..._ Property Line ..._ __-_.-__._. ¢ SEEPAGE PIT [ J Depth -_,�L-� _ Diameter ----- Number . __ ..............r Rock Filled Yes Water Table Depth Rock Size—.,:;? ��- Distance to nearest: Well ------------- _ ------_------------....Foundation _.__ ------- Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# ________ _ _ ------------------ - Date -----_--------------- ------.---.) Septic Tank (Specify Requirements) - - -- -------- - - - - ---- ----- -- ---- --- ----- Dispo I Field (Specify Requirements) (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 becom s ct to Wo man's oml?,91ation laws of California." Signed - ----------- Owner Owner /�,.' - Title es.r�+C .._ ... -. .. ... By --- C/ ---------------- (If other than owner) 10 F05 DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - .............................................................. DATE ....... BUILDING PERMIT ISSUED ____________________ .....•.....___DATE ....... __. ADDITIONALCOMMENTS ----- ........................................•-------•--•----•---------••----•--...---------••-•--•--•-----..----- ..................- - --------- ---- ------------------ - -•--- .................. ----•--------------------------------••--------- --------------------------------------------- ...................... --------- ---- -- -•----•--- ----- ----- - -------------------- ----Final Inspection by: ----•- •----------- -- ----•--- . ... - Date SAN JOAQUIN LOCAL HEALTH DISTRICT c.-D