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/// OR CE USE: �!k APPLICATION FOR SANITATION PERMIT ------ ---- ------------- ----------- (Complete in Triplicate) Permit No. _7_Z_r� " Date Issued _________________________________________________________ This Permit Expires 1 Year From Dote 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 w' h County Ordinanc o. 549 and existing Rules and Regulations. , a v `- JOB ADDRESS/LO ATIO �j -. -- ----------------CENSUS TRACT _-�-- -�------------ -�-- --{- -------------- - -- Owner's Name ------------Phone --- Address00 -- --------------- City . w----------------------------------------------------------- Contractor's Name __ . License #`-_�_!fS _ _ Phone ---------------------------___ Installation will serve: Residence [] Apartment House❑ Commercial :❑Trailer Court i❑ Motel ❑Other -------------------------------------------- " Number of living units------!----- Number of bedrooms -_J�___-----Garbage Grinder ------------ Lot Size 2-a'a_&" ��--m-._.___-__-_____ Water Supply: Public System and name—A_______-__ ~ "— =-----=---------- - _ — : --------=-------------Privateer Character of soil to a depth of 3 feet: Sand Silt❑ Clay 4�1�eat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe.M Fill Material ____________ If yes,type ____________________________ ,f � f (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) V NEW INSTALLATION: (No septic tank or.seepage pit permitted if public sewer i availa within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK* Size----/_I;,— ✓�,1_ , ______ Liquid Depth ._�'-__�`_________,____ C Capacifiy t'1 _ _______ Type �l�-_ __- _ Material(��l Z PNo. Compartments __ 7-_._-_ Distance to nearest: Well ---------------------Foundation ---------------------- Prop. Line --------------------- LEACHING LINE [ t No. of Lines __'_ ---_________________ Length of ,,e//��ach line_14Q------- Total Length ,.e' . __....._.._.-_ 'D' Box 1. Type Filter Material ,N1T_______Depth Filter Material _19-1.11--------------------------------____ Distance to nearest: Well __ _ ________ Foundation ............. Property Line, .. .............. SEEPAGE Piz [ ] Depth { Diameter ___�__� Number �._-__._ ock Filled Yes E]-, No - r y, Water Table Depth -----------------------------Rock Size ' . ................. �e Distanceto nearest: Well --------------------------Foundation _ - ______ Prop. Line _t1_.�_"_.__________. REPAIR/ADDITION(Prev. Sanitatiorr`Permit ____________________________ Date ---------------------------------- Septic _______________._____________Septic Tank (Specify Requirements) ------------------------------------------------------------------- Disposal Field (Specify Requirements) --------------- ------ -------- ----- ---- - ' ----------------------------------------------- - ------------------------------•-------•- ---- ----------------------- ---- -------- ' - ----------------------------------------------------------------------------------------------- ------- ---- --------------------------------- (Draw ------------------ .-----(Draw existing and required addition on reverse side) I hereby certiiy'Ah t I'have prepared this application and that the work will be done in a'cc'ordance with San Joaquin County Ordinances; State Laws, and Rules and Regulations-of the-Son Joaquin Local Health District. Home owner or licen- sed•agents signature-certifies the following:.— "I ollowing:."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 bec . ubject to rkman's Compen' on'laws.of California." t Signed __ _ ____._ Owner By -------------------------------------------------------------------------- --- - ------------- Title --,-------- (If other than owner) FOR PEPARTME T USE ONLY APPLICATION ACCEPTED BY C - `S- --- -- DATE ---- Z-------- BUILDING PERMIT ISSUED -------------------------- --------------DATE ------------------------- ------ ADDITIONAL COMMENTS ---------------------------- = ------------- - -------- ---------------------------- --------------------------------------------------------------------------------------- _ Final Inspection by.. 1 --------------------Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M A-'"''�"`'^� ' — j