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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. .7`�.•:••7��• .........I.............. (Complete in Triplicate) Date Issued ............. ..... Exp ......................................... This Permit Ex ares 1 Year From Date Issue l the work Application is hereby made to the San Joaquin Local ih Health Di tPorOrdinance plVom549 and existing Rules it to construct and tand Rt:gulat arein described. This application is mad in p� Scde s'� CENSUS TRACT .••,••.................... .•�T��u ...... TION � il�:..; �¢�??�•>� - JOB ADDRESS/fA Phone .................................... Owner's Name . .t .�.e.�#. l4.EhL.E'. _ ..4� ............................ ....... ...................................................... p... �i?.� ..+�_ l Ct7�(?. :L... .................... city Address `1��.�-� ... . 81. ........ Phone . • License # ......... Contractor's Name Installation will serve: Residence 0 Apartment House] Commerclol OTraiier Court 0 Motel ❑Other . ! ••- Number of living units:. �N Number of bedroomsI�° -Garbage Grinder ...!4O•• Lot Size .� `�............ Private Water Supply: Public System and name ...............• •-------------•----•••••---••• -t-0 y fl Cloy Loam ' Silt -Cloy ❑ . �PeaSand Loam Y Character of soil to a depth of 3 feet: Sand j]. ❑ Hardpan ❑ Adobe 9,—f III Material ............ If YOs,type Fowln size of llot, location of. system In relation to wells, buildings, etc, must be placed on reverse side.) (Plot plan, sh g f NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is avallable within 200 feet,) r, J r 7i �... ..._ Liquid Depth .. .. r PACKAGE TREATMENT [ ] SEPTIC TANK S146... Z� /__..... ••• -- ... i �. -•- TYP® Material�`trz� � • No. Compartments ........... capacity _ . . ................. t d r }n i Foundation ..•.. ... P 0 �-- Distance b nearest: Well ..��--••--•....-_..._. / �� If 4v.. .. Tota Length ............................ © 4 ,� .-....._ Length of each line.__. --•--• LEACHING LINE [� No. of Lines ..... .......... ., - .. ..Depth Filter. Materia} .-.,l.. ...................... ; . 'D' Box Type Filter Material... ••••-• r '� Property Line .............. Distance to nearest: Well ..� Q••• Foun ion ........ , N ....._. Rock Filled Yes o �❑ n Diameter `Amber ..._...---�•--•---•- b SEEP PIT K Depth .----•-• .. Size Water Table Depth ................. ..........................Rock ._ z 3L'� - . •-- Prop. Line .....��r..... Distance to nearest: Well............... .... . .Foundation ..... p• REPAIR/ADDITION(Prev. Sanitation Permit# ............................................. Date a - ............... .•---------•----............................. ........................ ........ Septic Tank (Specify Requirements) ................••-.• _ Disposal Field (specify ••--•••••.................................. I �Regvirements} .---••-•••--• - Y !!, ............................................................................-....................... .........................................................................................;_......._._• _. .......................... 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, StateLaws, and Rules and Regulations of the San Joaquin Loral Health District.Home owner or )icon- sed agents signature certifies the following: ermit is issued, I shall not employ any person in such manner "I certify that in the performance of the work for which this p as to become subject to Workman's Compensation laws of California." ��.A � .-` -.----- Owner Signed � r�o01 g ..------•-- t .. 3itle . .. .. ... ..... --.'�" (if other than owner) FOR DEPARTMENT USE: LY i ......... I --:..:.......................... DAT7. APPLICATION ACCEPTED 8Y DAT -- ..... �.. BUILDING PERMIT ISSUED - .........................•• ; ... ................... ADDITIONALCOMMENTS ...---••---••-.....----••---••--••----•-..._._....--•-._...•.................................................. .................... _ ............._...... ----•-. •-........................................._... ..._...._.............kyr:•-• .........................._-- ... .... .�r -•.................Date .:/...... . k}; Final Inspection by: ...: ... i SAN JOAQUIN LO L HEALTH DISTRICT 7172 3 M e_.. C�A - -