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t•vx vFic use APPLICATION FOR SANITATION PERMIT .................. ...................................... Permit No. (Complete In Triplicate) . Date Issued .. .. ........................ • A This Permit Expires I Year From 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 and existing Rules and Regulations, JOB ADDRESSAOCATION ...7./. !�V--......�� .8 � i................................CENSUS TRACT .......................... Owner's Nome ...........bQ.F�...7.H--- ..y --- N. F ,�.7`�...............................................y—� Phone .............................I...... Address lkrl..... 1 �.�l�i..} 90-. .1`1 .R ....... C o©fK / Contractor's Nome �/ ........ :...--•-•.................................License # ........................ Phone .............................. knstallation will serve, Residence EtApartent House Commercial QTrailer Court 0 Motel❑Other t Number of living uitita:.....•-..... Number of bedrooms . ...Garbage Grinder Lot Size S� x I-1-0 ` . Water Supply: Public System and name ........................, .........._..................---= f------•---• .................................. Private Qom...... Character of soil to b depth of 3 feet: Sand T3 .Silt Q Clay ❑ Peat❑ Sandy Loam fEr Clay Loam ❑ `Hardpan❑' Adobe fl Fill Material...... .. If yes,type kv ri'Iot plan, showing size of lot,-location of system. in relation wells, buildings, etc: must be placed on reverse side.) NEW INSTALLATIONS (No septic tank or see pit permitted If public sewer is available within 200-feed j-, �� PACKAGE TREATMENT [ SEPTIC TANK Size....�f. :.� ..... Llquid-Depth .:f.. .................•-� t Cay`acl / O Q P�ECf}ST' .....:` ... .�� ......: p ty ypa - .j. . Material_ , c)�No. Compartments .... . .. .0 Distance,to nearest:'Well~t .... ..................Foundation . Prop. Line • ............... .. ..... LEACHING LINE No. of Lines ......I............... Length of Bach I ne--�._-., .:f._.... Total Length ... ..Q.......r F1-�R T3 ED 'D' Box��.-�.:�TYpaa—Fittor-Material:�._2 Z z= .Depth Filter Material �y....... : J ........... Distance to nearest, Well` ..:-4?��....... ....... Foundation -.lQ... ...... Property Line ...:" ..._.. SEEPAGE PIT Q } Depth =f...::::.......... Diameter .... Number Rock Filled Yes ❑ No Water Table 6"p ....................... .........Rock Size................................ . � t . 6stance to nearest: Well ............................ .. F------`....Foundation .........._..__..._. Prop. Line ...,..... ......:._.. G c REPAIR/ADDITION(Prey:Sanitation Permit-# •" '-4.......................... Date Septic Tank (Specify Requirements) .................................................................................................. ......_............._................ , Disposal Field (Specify Requirements) •_._.._ - ......................................•'...... ... ...... ................. k l (Draw existing and required add ition.on reverse sided I hereby certify that I have prepared�hlq_jpppL15R1Lqn and that t_hs work will he done In accordance with Son Joaquin County Ordinances, State Lows, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature,cortifies the following: "I certify that he Orman of the w9ft for which this permit Is Issued, 1 shall not employ any person In such manner as to beco Ct to Wo r 's Coma4risallon laws of California."._ Signed �1!�....., ........................................•••. Owner --------- ��....., 7itle ........................................................................ t By .....................: Y. / owner) -�-a-__ _ _••- -�-:. �,--.�.:�.,�-.�...,.,r __ __... _. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED S'B-Y-7 - DATE .....,.?.'.�.`�5........ :.................................................... .... BUILDING PERMIT ISSUED ....................:...... `' .DATE> ADDITIONAL COMMENTS .......................................................... 4 „ ..... ...............................................................................................I........ Final Inspection �.... Date .......-..�..............�........... .. . . .. ...... .... 13 2L 1-613 lay. 5 # SAN JOAQUIN LOCAL HEALTH DISTRICT 6/711 3M