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FOR OFFICE USE..-. !, APPLICATION FOR SAN1TATiO_N PERMIT P P ) _. Permit No. �, .-_7.�... (Complete in Tri !#tate ..:......................................... - •��-•--- This Permit Expires 1 Year From Date Issued Date Issued --- Application is hereby trade to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance qw, ith Count -Ordinance-,'�No. 549 and existing Rules and Regulations: 1 JOB ADDRESS/LOCATION�! ESS/LOCATION : I /_`G� :. ... ..............:................... 3 ----.......CENSUS 'TRACT ..............:........... Owner's Name .` Mr...... M � ��3 � 7 •• ---- - -------- ......-----.Phone - ....--•---••----................ .. .. ....... ... Address ......-- :.... City Contractor's Name ...... .....................:......License # 7.._ Phone ..: Installation will serve: ResidenceA Apartment House❑ Commercial ❑Trailer Court 0 A' 1 Motel 0Oher-------- ............•-•............. Number of living units:_../.:._ Number of bedroom -----Garbagp Grinder _.__. Lot Size Water Supply. Public System and name ._._ d;l ✓�_ -•.�-'�. � i� kii ............................Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay [] Peat"[:] Sandy LoamCia Loam 0 Y D Hardpan ❑ Adobe Fill Material -------.... If yes,type --------------_--------_-- (Plot plan, showing size of lot; location of, system in relation to wells, buildings, etc. must be placed.on reverse side.l NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK-[ ] Size_......... ..................................... Liquid Depth I f ) Capacity _-----•----- Type ----------.._....... Material...................... No. Compartments Distance to nearest: Well s 1 s• --•---• -•----Foundation ------------- ------ Prop. Line ---•--.....----•....._l!7 i LEACHING LINE [ ]' No. of Lines ------------------------ Length of each line--------------__.: .- ........._. Total Length .---------•................. f � D' Box .----._-•-•- Type Filter Material ....................Depth Filter Mate al ..............:. ........................ ... _„Distance R nearest: Well ..........:............. Foundation .-._._..-_ ............. Property Line`^........................ .� ; SEEPAGE PIT [ ) Depth ........ .:.... ..... Diameter Number ............................ Rock Filled Yes ❑. No ❑ 13 Water Table•Depth Rock Size i D .....,Distance to nearest: Well .I •.......................................Foundation .................... Prop. Line � REPAIR/ADDITION(Prey. Sanitation Permit# ... Date ) j 'Septic Tank (SpecifyRe uirements �. q l ..... f ; - ................... ..---..._......._..------ 1r ..._ Disposal Field (Specify Re uiremen ) ------------------ ------------------- I , (Draw existing.and iequired 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 j County Ordinances, State Laws,-and-Rules-and-Regulations-of-the-San Joaquin-Focal-Health-District.Home owner,or liven- sed agents signature certifies the Following: j "I certify that in:the performance of the work for which this permit is issued-,-4 shall not employ any person in such manner 1 as to become subject to Workman's Compensation laws of California." II, Signed 6'. . ..---....- _ w •-. ..... O ner BY '.... _ .................. Title _ --.. : ,............. (If other an owner _ FOR DE RTMENT USE ONLY APPLICATION ACCEPTED BY ..:�.. �• " . DATE...._. . �= BUILDING PERMIT ISSUED i . .......:......... : ............. ......------. _ • `-" --DATE................... ADDITIONAL COMMENTS .y --• ----------- --- --•--•--• ................ ------ t --•-- -------- ------ .- ~ ..... Final Inspection by: .... .... .... T........- �J .... . ......................... .... .. Da e,.... . ................ �, SA1 . OAQUIN L CAL HEALTH DI --• -� STRICT .. 'I 9 E. H.13 24 1-'68 Rev. 5M 7/77 't u