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FOR OFFICE USE: APPLICATION FOR SANITATION PERMITV / — 1 t► Permit No. 7 � o/-•••• M (Complete in Triplicate) Date Issued /........ IM This Permit Expires 1 Year From Date issued ............... Application is hereby model 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 ADDRESS/LOCATIO II,.�.3 .3.__"." ..... .... . ............... CENSUS TRACT ......_..._........_.:::._ 0r Phone Owner's Name ........ Address I --•--- City .... ------ ......... ......... _.---- ".... _ Phone ... Contractor's Name -- ..._ "-- __.Q" l-.._... F Installation will serve: Residence ❑ Apartm:��❑ Commercial ❑Trailer Court [] I ' Motel ❑Other 4 ................. Number of living units:......_... Number of bedrooms _.-_-------_Garbage Grinder _.... . at Size .. l : Private ❑ Water Supply: Public System and name f '�N Character of soil to a deptof 3 feet: Sand❑ SiIf❑ Clay ❑ Feat❑ Sah dy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobex Fill Material ........-... If yes,type ................ . ......... I s {Plat plan, showing size of lot, -location of system relation to wells, buildings` etc. must be placed on reverse side.) ' NEW INSTALLATION: (No septic tank or seepage pit permitted-,if public sewer +s available within 200 feet,) _ If �' SEPTIC TANK e... ... ............ ............... Liquid Depth ...-�..� ....-.._..... PACKAGE TREATMENT [ ]I x � � �� t d k,?-Cy.... Material C�"�L{►". " No. Compartmeis ..._.�............ Capacity 00 Type I c� Distance to nearest. Well .-. ---.- ------------------Foundation ...1.�--- •...._.. Prop. )Line —57--- f -Length oit "c,7 ine ---....`�j� *........... Total Lengt4`/. -•Ga............. LEACHING LINE No. of Lines . pII !�Box TYpe Filter Material .. .Depth Filter Material -......../ff..--•--......-•••••-••--•. I I � tt ---------- Foundation / ?..---. ... Property Lie ... ............... Distance to nearest: Well _... 1_....--- SEEPAGE PIT [ } Depth Diameter ................ Number .----"-_. _ .....----.""-. Rock Filled Yes ❑ No �] t I� •- .... ..........` 'NX- -Rock Size -----------------..... Water Table Depth _----"-.----- � - Distance to nearest: Well . _,..Foundation ------------ -----"- Prop. Line .---..._......._...... I i!, � REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----- ---- -- -- ------------•- -- Date ..._..._......__...-.------------•) ' 11I -----•--------------- Se tic Tank (S ecif Re 'uirernents) •-". y ) Disposal Field [Specify Requirements) ---•- ----------------------•-••- -------- ....... ---.......- ... ......... --- ----.. ............................ z.:_.pp ---. . it _. ......- .. ---- -•---.............. .......... ----- ............... 1 (Draw existing and required addition on.reverse side) I hereby certify that I haGe prepared this application and that the work will be done in accordance with San Joaquin r County Ordinances, StateLaws, and Rules and Regulations of the San Joaquin Local Health District. Horn ]le owner or licen- sed agents signature certifies the following: "I certify that in the P erfci6ance of the work for which this permit is issued, I shall not employ any pen in such manner as to become subject to Workman's Compensation laws of California." f Signed .:............. .. . .� - ;_�' -, • --- --- ---�... .. _ Owner t I Title . .. �...... .......t....--.... ....... ...... By ' Ed (If other n owner) ARTMENT USE ONLY _. . APPLICATION ACCEPTED BY ..... .. ...... . ..._ _ _. .............. ..,—. " -•,.. DATE n DATE BUIL-DING-PERMIT-ISSUED � . . `. . � - ADDITIONAL COMMENTS�i...... .. .......... —-------------- ............. ........... ........... . ........................................ ............. �� .......: ................•--._._........ ------ s ---- .... .. .. ......-- ...... -- •......... ----------•----- Date � ----••-•--•------ Final Inspection by: -- ----------- -------------------- _ .I AN' OAwN LOCAU,HEALTF#,.bit T,Ri�T;' 7/72 3 ►K ., 1.3 24 o .. 9 k -