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FOk�.JFFICE USE: t APPLICATION FOR SANITATION PERMIT r.................. Permit No. - .---.._.. :..............:........................................ (Complete in Triplicate) .27 7-S- ..S-....... .........I............... ...............I............... This Permit Expires i 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 is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ...... �a -._ '0. .... ........ .................CENSUS TRACT ...... ....... Owner's Name .......... 12.7. . /...+�.�.�G�.t�....:.. .. .. = Phone ... .City _..... ... -; Address ........ ,�/r��------=•....................:...............•--...........---------•--._._._.. ...:T..:.-- -----1-....---...._._.._..------•------............_......... Contractor's Name .-- , «._.......ter ,t L�'_.. �(� .... :_..License # Phone Installation will serve: Residence ['Apartment House C1 Commercial ❑Troller Court 0 Motel ❑Other ---.........................I......... ...... Number of living units:.... Number of bedrooms .........Garbage Grinder.,/_Y0_..Aot.Size 1e457..Y1-S.,��.... ................ Water Supply: Publ ys rn and name .................... -•------ ---------------------------------------------------------------_...................Private ❑ Character of soil to a depth of 3 feet: Sand❑ Slit❑ .-Clay ❑ Peat[❑ Sandy.Loam 0 Clay Loam ❑ ; g Hardpan ❑ Adobe Fill Material ............ If-Yes,type ...................;----•_ (Plot plan, showing size of lot, location of system in relation towells,'buildings, etc. must be placed-on reverse side.) = NEW INSTALLATION: (No septic tank or seepage pit"permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANKf ] Si e---------------------------------------- ------- Liquid Depth'.......................... Capacityj,2t........... Type ..... Material/g- arJ�-w No. Compartments _._:�............� Distance to 'nearest: Weil ...................................:Foundation ..............._...... Prop.-Line ...................... LEACHING LINE No. of Lines ;..___ Length of each line................... ........ Total Length t ) ----- -- g . -•-•-- 'D' Box ............ Type,Filter Material ...._...............Depth,Filter Material ............................ .. .. Distance to nearest: Well ........................ Foundation Property Line ............ P SEEPAGE PIT O Depth .......... ......... Diameter-.,.................Number -----------................. hock Filled, Yes [3 No C] Water Table Depth ................................Rock Size a Distance to nearest: Well ........................................Foundation ......__.._ ........ Prop. line ............. REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ..................................) i Septic Tank (Specify Requirements) ........ ......................................................... .................-..------------......._-- ...._..-•--- _ Disposal Field (Specify Requirements) .............�.,`-------.,�.•.�.__�..a�.a....--•----��' �--._..., ....._..........._....--_-- --•----------------------------------------- ---------•---•--- -----------------------------------:.. .-•-------•-•----------...----------------•-------....__._..--. (Draw existing and required addition on reverse side) 1 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 iiten- 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 1''' Owner ---- .... -------- By ••-----•........--(If. .............`.. ... ...— Title ...2 __ 2�_ I_R. . (If other th owner} ........................ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY." ... ................. .................... . ------------------------------ DATE -.4 . L.-7 --7-��---------- . BUILDING PERMIT ISSUED .. • ..................................•--------••-------- ....................DATE .......................... ADDITIONALCOMMENTS .. /--------........................................................................ .._.....:.....__............. ------------------------ ------•------ .......... .......--......................................................................................... .....:............__......._-. .................•--- ...... ...... --- . _ _ ---•-------•----- ...... Finalinspection by: .. -----••......................•--••-•..................................Date�_. ...� 7 ......... SAN JOAQUIN LOCAL' HEALTH DISTRICT GfSF_ H_3 3 24 1. c5R Rpv. 5M 7177. 3 M