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t FUR OFFICE USE: APPLICATION FOR SANITATION PERMIT ,f b v ,...........__ .�. ...r. __..... Permit No. 7..�. (Complete in Triplicate) '............. {..._................................ :. • .. ..• This Permit Expires 1 Year From Data Issued Date Issued ..�"...b.I .7 } Application is hereby mode'to the San Joaquin Local Health District for a permit to construct and install the work herein i described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .. 0. ...:.........Sd----•- ...........:.LL., .:-...CENSUS TRACT ....... "-- # _ ..._...�......--- :� Owner's Name ... /��/ iL/ ........ 1 --------------- ---- Phone Address ...._:. Crit' - � �..�Z''r ......................... i ' Contractor's Name .rte.----- , .--•-••--•-•-------..License # /-7 .3.... Phone Installation will serve: Residence qApartment House`[`] Commercial ❑Trailer Court ❑ �i Motel ❑Other --------------------------------------••••• .. Number of living units:....1°"---- Number of bedrooms .. .--._Garbage Grinder _.fQ__ Lot Size ...... Water Supply: Public System and name .......................=------------.----------------------....................................................Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam l] Clay Loam ❑ Hardpan ❑ Adobe q� Fill Material -----._..... If yes,type ........................... 01 (Plot plan, showing.size of;lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.)'A NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within-200 feet,) m PACKAGE TREATMENT ( ] SEPTIC TANK J Size........................................"----... Liquid Depth ..... ................ Capacity ....... ............ Type .................... Material...................... No. Compartments ........... ......... Distance to nearest: Well ..................:.................Foundation..N.__•-_.......---- Prop. Lind................ LEACHING LINE { ) No: of Lines ..__._.--. -_- __- Length of each line........'.":-....-... Total length 'D' 'Box ------------ Type Filter Material ----•-:.............Depfh Filter Material ..._....__........ ............ Distance to nearest: Well . .---..... Foundation ....1...........::... Property•Line .................... SEEPAGE PIT [ ] Depth -_"..._..._ � . .' ---__--.. Diameter ---------------- Number ..._'.....__._..,�:.:--rRockiFilied_Yes ❑ Na.i❑ Water Table Depth -- ..... .......Rock Size ............•................... Distance to nearest: Well----..............4.........I............Foundation .................... Prop. Line ....._. ......... REPAIR/ADDITION(Prev. Sanitation Permit# ....._...-----•......--••••••--• ---------- Date ..................................� fY Requirements)Septic Tank 5 eci p I p q iremehts) ----•.................•_..._.._....-•.-......;..-•--.....••r•-•_.••-.............•..-•---•---•-•.•--•••....-•-•.-----..• -•- I Disposal Field ISpecify Requirements) = X ...... C (ham ---------------------------------.-------- ................................- --------- (Draw existing and required dddi4on on reverse s�e).` I hereby certify that I have prepared this application and that"therwork will be done-.-iinn,accefdance with San Joaquin County Ordinances. State Laws, and Rules and Regulations of fhe San Joaquin LocaleHeciih -wa rict. Homeowner'or Ilceei- r sed agents signature certifies the following: "I certify that in the perfor"nce 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 California." Signed Owner B ----- --------- •.... (If other than own FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ..... . . -• --•------•-----......-•--------------•• DATE ......� . .._. _._......_.........._..... ! BUILDING PERMIT ISSUED ------ -- --------------..................................................................:.........••• DATE ------------------------------------ ...... ADDITIONALCOMMENTS . ......-.........................•••-••••--..__......------••-•...._._....-••-----••- ............. .................................Ii... .......................................................................................................................•-•-.............................. .................................................................=--------------._._...... --------------------------------------------.------------------------- ....... Final inspection by: ....•••........Date .-..�.. _ .. .� .................... SAN JOAQUIN LLOCAL HEALTH DISTRICT 7172 3 214E_ N_13 241_'68 Raw. SM _