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FOR OFFICE: USE: APPLICATION FOR SANITATION PERMIT -:----------- -- ------- ------------------------- y, ... Permit No: -7-Z - 8 v i 4 (Complete in`Tripficate) r ----------I----------- ---_-------------------------- I ._--------------- ------ This Permit Expires 4 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=;comIijnce with County Ordinance No. 549 and existing Rules and Regulations: _ 4 JOB ADDRESS/LOCATION .---------''— ------------------ U I/q1' CENSUS TRACGT_ Owners Name _Q}-�/U------ltl------ wyy ki— --------------------------------------------------------Phone ---Address ----------« f� 3 �.� Y'Q-----:--------------------------------- City -------- ---------------•-----------------------_ Contractor's Name ------------------------------------------------------- --------------------------------.License # ---------:------------- Phone ------------------------------ Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other _.: -------------------------------•-------- 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'❑ Sift❑ Clay ❑ at ❑, Sandy L El Clay Loam ❑ Hardpan ❑ Adobe'❑ Fill Mate di ------------ If yes,ty•e ---------------------------- (Plot plan, showing size of lot, to tion of stem in vela i n to well buildings, etc ust be placed on reverse side.) NEW INSTALLATION: { (No septi tank or ep ge pit perm ed if pu tic sewer is ailable within 200 feet,) PACKAGE TREATMENT [ ] SE TIC TAN: ] ze----------- ---------- ---------------------- Liquid Depth .----- :---_---__--_--- Capacit ---- ----- ------ pe ---------- -'---- Mat r.ia --------------- ------ No.. Compartments ---- ---------........ LU Distan to be est: e!f ------------ --------,---- --------Foundation -___-_._--.------_-. Prop. Line -_-__--_---__-----.- t LEACHING LINE [VDnce Lines! Lengt oath line---------------------------- Total' Length _-----I----- Typ Filter Materia/--------------------Depth Filter, Material -`-----------------------_------_-_-------- to riea s Well----______------------- Foundation ______---------.------ Property Line ------------_----.---.- SEEPAGE PIT [ ] _'-__-_'_-----.-- Diameter ---------------- Number ----------------------- ---- Rock Filled Yes ❑ No i❑ iable Depth ; i-------------- ---------Rock Size --------------- to nearest: Well --------------------------------•-------Foundation -------------------- Prop. Line ...................... i REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------------------------------- Septic ---------------------------_Se tic Tank (Specify Re uirements - ---------------------------------- Disp Meld ements) _------ _-_srV .-7e-_ a419__-? __ / Specify Requir � d al �ls r -----------------------------------------------------=------------------------------------------------------------------------------------------------------------------------ -------------------------- % (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 be _c e s lett to 4,_r_.m an's Compensation laws of California." Signed - - - Owner BY ------------------- ------------------------------------------------------- Title ------------------ - - --------------------------------------------------- (If other than owner) P ENT USE ONLY y APPLICATION ACCEPTED BY ---- --- --- --- -- ------------------------------------------ - DATE BUILDING PERMIT ISSUED . ---- - -- ------------ ---------------------------------=--------------DATA------- -------------------------------= ADDITIONAL COMMENTS----------- --- ---- ------------------------------------------------- --- --------------- ---- ------------------------------- -------------------------------------------------------------------------------- I ----- ----------------------------------------- --- ------------------------------------------------------ ------------------------------------------------------------------------------- ----------- ---------------------------------- FinalInspection by: ---------k----------------------- ----------------------------- --------------------------------Date ----------------------- -------------------- - SAN JOAQUI1`LOCAL. HEALTH;DISTRICT E. H. 9 1-'b$ Rev. 5M