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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ............. ..................................._: Permit No. 7 S'S�2 2— Complatein Triplicate) �_ _ _ ^ _ _. • �_- _ _ T. This Permit Expires 1 Year From Dote 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: .. CENSUS TRA JOB ADDRESS/LOCATION CT ...�. j .......................... Owne'r's Name _.. ..._L/_._. .................... .Ph .............. ............................. : ..... one -•.-........................ ........ ... Ci Address ......................... ..... .... ........ ... ........•...••--... _.._.._.._.......... city .............._. ............ / _ t �. `...... License Phone Contractor's Name /�-. : .. ..�. �/" Installation will serve: Residence MApartment House❑ Commercial'oTraller Court 0 Motel ❑Other ...................................:.....••-• �. k_t . Number of living units:............ Number of bedrooms ..........._Garbage Grinder ............ Lot Size ...... Water Supply: Public System and name ...............--------------------- -- _-•• .._.. ......._ ...M, ............_....Private- Character of soil to a depth of 3 feet: Sand❑. Silt[3 Clay ❑ Peat 0 Sandy Loam fl• Clay Loam Hardpan 0 Adobe 0 Fill Material ............If yes,type.............I. ............ ]Plotp#an, 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 isavailablewithin 200 feet,] - L ..: ..PACKAGE TREATMENT SEPTIC TANK[ ] ize.� � ..:. Depth ..... .Li uid Capacity _/._%Z_047--- Type I --. Material..,....... No. Compartments oa z Distance to nearest: Well .._ f __._..Founda#ion 1.49.......... Prop. Line . .- .... LEACHING LINE ( ] No. of Lines --- ----- Length of each line...... ................ Total Length --- ,.x�........--•� 'D: Box -� Type Filter Material .:.......:..........Depth .Filter Material .........._...._.............. i - Distance to nearest: Well Foundation Property• Pro Line i ................ SEEPAGE PIT { ] Depth .................... Diameter ................ Number ......................------ Rock Filled Yes ❑ No Water Table De Depth ----•- -- p Rock Size ................ Distance to nearest: Well ...........,. . i�oundation Prop. line .............. ••---- ------........... ...................... 0 ,, REPAIR/ADDITION(Prev. Sanitation Permit .:....:....::...:.•-••...._ ::_t::....... ......................... _ - . ........ Septic Tank (Specify Requirements) ....... `............................................................ .... ....•-•-._...........� 1- Disposal Field (Specify Requirements) ------------------------•---•-•••-•--- •-....._.....-••••.. `...:'_....--•--•--- .................................... ....-...._:___. .....:_..._..--- ._.. - ----------------- •- -_ ........._._..----••---•....-...............-••••-•----..............._..... !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,Disirict. Horne owner or licen- sed agents signature certifies the following: ",11. certify-that In.the performance of the work for"which this permit is Issued, I shall not employ any person in such manner to become subject to Workman' mpensation laws of California." G Signed.: --•----- - ---- --------------------- ---- .. ---------•••-- Owner ��: By ----- - --- ----- --- -- r.. ---- •---------........_._. Title :.. a llf oth r han owne FOR DEPART NT USE ONLY — --- DATE APPLICATION ACCEPTED BY -- - - ----- -- -- . .. ................................... BUILDING PERMIT ISSUED h-----•------•----- -- DATE . .......... ... ................ . . ADDITIONAL COMMENTS .:�. --- ----- - - - ..........................•-_..._ .... .. ------------------------------- . . _.._.. _-- ....._.._..... r --- --•------ .--�-- ...----•----•.._..---._Date ...... Final inspection y: .•--•.-•-- -.-- ....!&fA�� �'` Eli 13 2W' 1.68 Rev. 5M 5 N JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M