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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ............... (Complete in Triplicate) Permit No. 7 .._.•_•••••••, This Permit Expires ] 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 its made in compliance with County- inance No. 549 and existing Rules and Regulations: JOB ADDRESS/LO N 1 � 5 ..... --Lr �.. �...................................CENSUS TRACT Owner's Name , Address .......... ,,.._.-..... Phone..................................... City .......... . f Contractor's Name .......... t.,� .. _. - .....License�# _l��•y Phone .. one '.... ............... Installation will serve: Residence partment House 0 Commercial ❑Trailer Court 0 Motel ❑Other :'.... 0 Number of living units,.--....�..- Number of bedrooms ..- �- /...Garbage Grinder ............ Lot Size .. e--e-�:�-••��— ater Supply: Public System and name ....:........................... ..... + ................._...._....-_....... `:-... Private Character of soil to a depth of 3 feet: Sand Silt Clay n ❑ Y ❑ Peat❑ 'Sandy Loam Clay Loam ❑ Hardpan [j Adobe [3 Fill 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.) i NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,} PACKAGE TREATMENT [ ] SEPTIC TANKj Siae. ...... Liquid Depth .......................... Capacity ..---------••-•----- Type ............... .... Material.............. .... Na. Compartments Distance to nearest: Well ............ ... ... Foundation ..... ....-•...•....... Prop. Line .................. LEACHING LINE [ j No. of Lines --------------- ------_ Length of eachline........................---- Total Length .........__........... . l T. 'D' Box ............ Type Filter Material ....:-----_........Depth Filter Material ............ f" Distance to nearest: Well ............... ,Foundation . Property SEEPAGE PIT { ] Depth .................... Diameter .... Number :---------------,............ Rock .Filled Yes ❑ No r❑ ' Water Table Depth ............................-...................Rock Size Fa Distance to nearest: Well Foundation ' .. Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit!# ............................................ Date Septic Tan ;(Specify Requirements) .....___...................... --•--•-- —................. •••----------------•...._ Disposal Feld (Specify Rf quire encs) 4 5 _ ...- -- ' �y Re �, ' n , 2� , ._� .. ... =-------------------- !. ................................................. ---•-------.......................................---....---••--•--•••. -------q ------------.......................................I........... (Draw existing and required addition.on Lreverse side) I hereby certify that I have prepared this application and _that the work -will be done In accordance with Son Joaquin f 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 become subject to Workman's Compensation laws of California." Signed ....... ............. ---•- - - ------ •- Owner BY ----••------ itl (If other than owner} ............:...:...... FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY........... - •_ ----•---•.. .. DATE ....... .. ..°..-.... . ... BUILDING PERMIT ISSUED ............-• ---• ....._. ADDITIONAL COMMENTS --------- --------- ...DATE ..---------•••......•--• ...................I'll.....................................•..--......-.................•...... ..............................•.............. ---...... Final Inspection by ..................................................... ----.Date . . s .l _. "i............... s. SAN JOAQUIN LOCAL'HEALTH DISTRICT .—E. H.13 241-'b8 Rev. 5M 7I79 'A %c