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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----- ....---------•-��~-I---- •-------.....-'------ .-.:.-�: �' Permit No: .................�. '1 (Complete in Triplicate) ................. --------------- 775S 6 ................... 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 County Ordinance No. 549 a existing Rules and Regulations: (T �� C c .. 00, JOB ADDRESS/LOCATION f� - Y + �- '-G!/..... � CENSUS TRACT � - Owner's Name - ----- ----- ------ - • --- . -•------- --------- -- Phone -••----•-----------•--•-......-- Address / l{ •r -----•------...... City . ... 10 Contractor's Name ---- -•--- •• --- -----------License ... Phone 7�0 Installation will serve: ResidenceX-Apartment'House❑ Commercial❑Trailer Court 0 •'' / Motel ❑Other .'n.....:...............•••... --------- Number of living units:....1__---- Number of bedrooms`.Garbage Grinder -•-------- Lot Size ............ Water Supply: Public System and name ---- :� '- •---- `-----•i •-- --- ---- - - Private Character of soil to a depth of 3 feet: Sand Silto Clay ❑ Peat❑ Sandy Loam ❑ Clay-Loam : X Hardpan ❑1 f Adobe 0Fill 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,) // 00 PACKAGE TREATMENT [ ] SEPTIC TANK Siz .5� _9•�---------------------- Liquid Depth ._-7.-.•-4n.....,..... Capacity 8 _ ! ( --- Material___ No. Compartments --. __-- ... �� TYp --- - Distance to nearest: Well -------------------Foundation .. Q_______.__. Prop. Line _ LEACHING LINE ] No. of Lines'".../...---...... Length of each line......O-Q------------- Total Length ,_ Q`............... • 'D' Box• ________ Type Filter Materlal�/�41P-Depth Filter Material ____- ......----------:........ .__._ Disfance to nearest: Well ________________________ Foundation ------------------------ Property Line- ......._:. ............ z SEEPAGE PIT [ 3 ' Depth ____________________ Diameter ................ Number ............................ Rock Filled Yes ❑t- No 0 WaterTable Depth --------------------- --------------------------Rock Size ................................ Distance to nearest: Well ________________________________________Foundation .................... Prop. Line ....................... REPAIR/ADDITION(Prev-Sonitation Permit L# -------- ----------------------------- Date -----_--.-.-.-•-----------------__) Septic Tank (Specify Requirements) -..... ............. -------., ----x -----------------------------------•----.................. Disposal Field (Specify Requirements) y ; ! __ _ -•---•••-----•••••-•-••--•------------------------------- ------------------------------------------------- ---------------------------------------------- ................................................. (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"thot in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of alifornia." Sig ---- - -;--- f ner .- •- - BYr _ . itle --- -------------------------------- iii other than owner} �4` . FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BYE c-[ --------------------------------------------------- -------- DATE .. �5-- 7F------- BUILDING PERMIT' ISSUED --- ----------- .......... ---........ ..................................---.................DATE _-_--------------------•------------------- ADDITIONALCOMMENTS ---------- -------------------------- ------------------------------------•----------------- =-•----....... ......................................... •-• . --- .--•••-••--•--•--•---------•-••--••------•---------------------•••••••-• --------------------------------------- —Final Inspection by: - � -.. .. . .._.... SAN JOAQUIN LOCAL HEALTH DISTRICT