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FOR OFFICE= USE: �; APPLICATION FOR SANITATION PERMIT - ...................... Permit No.7 :. ...3.: •. (Complete in Triplicate) Date Issued ......................................................... This Permit Expires ] Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to, constrcict and install the work herein described. This application is made in compliance with County Ordinance No. 544 and existing Rules and Regulations: JOB ADDRESS/LOCATION .. y.:.:...-.---- •--•----• ... . ............................ TRACT ..Ql................. CENSUS a �sa-�( ...... ................:........ ..:.........P Owner's Name ...... hone :.. •• _.�.1�..... 2-7 City Address ..'.......................__._.. .. ..._..�_.e. _. . .. ... ____...__._._.__.._......... CI .._.---.... .. --- -• • - .. .. ...... .......... Contractor's Name ................ ....... ...... . .... .. ......... License #Z .. ... Phone .... `.t�..._._. .. Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Court 0 Motel ❑Other __. ------•• Number of living units_____________ Number of .bedrooms . ......... arbage Grinder ............ Lot Size ...1...................._.................. � Water Supply: Public System and name ................................................ --------............. .........................................Private ❑ Character of soil to a depth of 3 feet: _,_ Sand T-1 ❑ Clay. ❑.,; Peat❑Sandy Loam 0 Clay Loam Hardpan ❑ Adobe 'Fill-Material ----_..._.._ If yes, type -------------------------- (Plot plan, showing size of lot, location of system.in relation to wells, buildings, etL must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage.pit permitted if publ€C sewer is available within 200 feet,) fr PACKAGE TREATMENT [ ] SEPTIC TANK Size.............. r)S._ . --------- Liquid Depth _ 51. ..•-•........... Capacity/.. ..... .... .... Type _l T..----. Material..�..�1.7tin No. Compartments _..3 ..:.......: Distance to nearest: Well ........................ . 4-,.,.Foundation _ lD.."? Prop. Line . __.?`:.......... k -,-.Foundation r l (D LEACHING LINE �Q No. of Lines .......�----•.--_-.... Length of each Cline.---.lC? _____________ Total Length ..... .._.._.......... 1. � 'D' Box ....tom---- Type Filter Material - . ... .----Depth Filter Material ......... �'............................ Distance to nearest: Well . ..................... Foundation ...eo'!P ....... Property Line :. ................. SEEPAGE PIT [ ) Depth ----- �-..:.._._ Diameter Number ... ...... _________ Rock Filled Yes )?f No ❑ T$ Water Table Depth ..... .......------•----------------------------•----Rock Size�. :.----- -� ............. 1 Distance to nearest: Well ..E........:............................Foundation .�141.-x`':.. Prop. Line .. "'..__._.. k REPAIR/ADDITION(Prev. Sanitation Permit#...........I---------------------------------- Date .............-k................... 1 :�. Septic Tank (Specify Requirements) ------------------•.........------•••----•---•-•-•-•-••--•----------•--•••••..... ..--••................................................. Disposal Field (Specify Requirements) ........_........._ _ k _ ----------------------------------------------------------- ----•-•- -----------------------------.--------... --• .------.. ........... (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work.wili ,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, 1 shall .not employ any person In such manner. as to become subject to Workman's Compensation lows.of California:" Signed ..---•-•.......... . r e .....• ••• = --- . ... . ..-------=----------..........---•----.. Own By ................ .. . . .;`..---_ - - --- -------------------------- Tu i`— e ' (if oth tan.owner) %ali t ` ' FOR DEPARTMENT USE ONLY W 11 � APPLICATION ACCEPTED. BY,. d' *^^, .I --- - _ .-.,._.».. l DAT I '.? ..... _ ............ BUILDING PERMIT ISSUED --- sDATE ...==......:......: ADDITIONAL COMMENTS ----•......... -------- -_-- .- . :... ..........-- ••.... !-------------------------------------------- ....... .. .. . -----------------......................•------................................ ...................� .�....-- ti r7- i 6 .............. r s %. .., _. . f .--•-•-.Date j .... ...... Final inspection by: .- . ___ . .. . '.'SAN.,JOAQUIN LOCAL HEALTH DISTRICT F_ W_1.3 24 1.'6a Rev_ 5M 7/72 3.1