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FOR OFFICE USE. - 3� APPLICATIOWFOR SANITATION PERMIT .............A :------------- 3—�31 (Complete in Triplicate) Permit No. .-7.......___.._... �; Date Issued ---------.....................,--•--.----------, .. This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per 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 ADDRESS/LOCATION .................. -- G. '. ..............---------_.........CENSUS TRACT Owner's Name .-.,..Phone .,.., .... ..i...�.Q.fes...........:................. .•--•----• ._. � � e .................................... Address ............................ .3� e .�-r'o'w .... C;ty .. � .NG� ..............................--- Contractor's Name ....--- . d .. . /fid ..-- ................. ------------- Installation # f-:��Phone Installation will serve: Residence �partment House 0 Commercial ❑Trailer Court 'o 1 � 9n X Motel []Other ............................................. Number of living units------!.:_--- Number of bedrooms ....Y.-._.Garbage Grinder Lot Size ................ t - Water Supply:.Public System and name !..-•....... ........................................................................_.._Private o _. Character'of soil to a depth of 3 feet.. Sand b Silt❑ Clay E] ' Peat❑ Sandy Loam fl Clay Loam C]-- -�--� • — --- _» Hardpan ❑ Adobe { III 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.) NEW INSTALLATION: {No septic tank or seepage pit permitted If public sewer is within 200 feet,) 4` ti -_ .. .. __. • S- f PACKAGE TREATMENT ( ] SEPTIC TANK fA U Sze...... .......... Liquid Depth _45................... Capacity ......Typo_ _. MaterialL�t�uz- No. Compartments .. :.............. 1 71 00 Distance to nearest: Well ------ -- -------------Foundation ---��- --__._.. Prop. Line . ..�........... LEACHING LINE [ Na. of Lines ______________ __ �- ______. Length of ach line.._---. - .__ Total Length 1. �................f�b 'D' Box . @_ _ Type Filter-Mdterial . .........Depth Filter Material ............................................ ! Distance to nearest: Well ... .-_--_ --_. Foundation .... Property Line ......... n ; � SEEPAGE PIT [V,-' Depth ..rZr�. ....__. Diameter _�.�i.....__. Number .....................:...... Rock Filled Yes No Q Water Table Depth .............. .CA. 1 3 Rock Size _1'.12--k-- ............ Distance to nearest: Well 1 ..1 .......Foundation _._ .©. .. Prop. Line ............. REPAIR/ADDITION(Prev. Sanitation Permit# .............................. ............. Date ..................................] I f Septic Tank (Specify Requirements) .......................... ....... ......_..............................._....... ....... Disposal Field (Specify Requirements) - - .} ------------- ----•------------------------------------------------------------------------------------- ' . `I •-------------------------..:_..------------------•-,................................. ......................................................... (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 become subject to Workman's Compensation laws'of Callfarnia." 4 Signed _._ _. ........................ --- •....................4.....-- ...............-Owner _......._.By __ ........ . ...............'Ttle ........ <._....... ....... (If other than owner) , FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ...... ..V I... DATE .... BUILDING PERMIT ISSUED .. ---------------------------•-----.DATE _..... .................. ----- ADDITIONAL COMMENTS ..._ .. ------?�r� ,"? ..............-...................................................................... ----------•---------------------------- ..... .............---._......... .......1----------------------- ................ Finalinspection by: . - ----... ... •...... --•-------•........:.................•...........................................Date ... -_�........... SAN .JOAQUIN_LOCAL' HEALTH DISTRICT _ F H 13 24 i.-AR Rav_ SAA 7/723-24