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FOR OFFICE USE . APPLICATION FOR SANITATION PERMIT. 'Permit No. .. 6.� (Complete in Triplicate) P .... ................................................. Date Issued ��-. 7t This Permit Expires 1 Year From Date Issued ......I.......... Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work heroin described. This application Is made In compliance with County Ordinance No. Sag and existing Rules and Regulations, , JOB ADDRESS/L ON ....�/ /3.--.. . . .... ....... ....................................Ct:NSIJS TRACT ..................... Owner's Name / .. ' i _ � Phone .................................... Address . 7Y -Gt/ L �`' ..................Citi/ ..._. ./..._. -............._.. Contractor's Name _`_ .. ......... ....License #x.7. 5 3.e _. Phone. .. ..... installation will serves Residence Apartment House❑ Commercial❑Trailer Court E Motel ❑Other Number of living unita:..../.. Number of bedrooms ../_......Garbage Grinder ...... ..... Lot Size .�'.�f�................................... Water Supply: Public System and name ...........................................................................................................Private` Character of soil to a depth of 3 feet: Sand❑ Silt Q Clay p Peat❑ Sandy Loom ❑ Clay Loam ❑ Hardpan❑ Adobe Of fill Material ............If yes,type ........... ............ (Plot plan, showing size of lot, location of system in relation to wells, buildings, ate. must be placed on reverse side.) NEW INSTALLATION: lNo septic tank or seepage pit permitted if public sewer is available within 200 feet,) ...'�................... PACKAGE TREATMENT [ � SEPTIC TANiC�Gj� 'Siz .......................•• Liquid Deptlt Capacity /0.. ........ TypoP� �. Material.4 yl►�r , ,..... Na. Compartments ... .. r.......... Distance to neares : Well �......._ FoundationQ.......... Prop. Line BEACHING LINE I No. of Lines .......1............... Length of each line........ ............... Total Length ................ 'D' Box _--.. -.... Type Filter Material` l.: !!.� Deptk-Filter Material ....../. ........... .. �.:. - , Distance to nearest: Wellkr ?RQ.. � �Foundation�:.. ........... Property line ..:�... ...�.....`.... SEEPAGE PIT [ Depth ....2..$.r...... Diameter 3...... Numbers....... . . ..46.. Rock Filled Yes No Water Table Depth .....�1&a................... . . ._.....Rock•Siza ... ... .. .............. r Distance to nearest: Well L>A..•._::..................Foundation-..5?49.......... Prop. Line .....-....... REPAIR/ADDITION{Prov. Sanitation Permit F f ...-.. •............: Qafe .. .......... Septic Tank {Specify Requirements{ .: .. �.,..r ._ �x Disposal Field l5pecify Requirements' ...,C.�:�L. �� .« ........................ .........................................- .. /.... '.... . .. .... ........... .......... ........._ . ........................................................................... [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 Heald+ District. Home owner er ficin• 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 bet su lett t Wark: o ' _Compensation laws of California. .` Owner sy - ...... ... ....... . Title .... (If other than owned � � �. FOR DEPARTMENT,USE-ONLY APPLICATION ACCEPTED BY ...... . . . ..... .............................................. DATE ....... ... .......... BUILDINGPERMIT ISSUED ................... .................,...................................................-...............DATE>.........."...................---•-........ ADDITIONAL COMMENTS .... ............................... . ........................................................................................................----.............................................................. Final Ins action b ..................................Date ... D .. .. ....---- p y: ........ .. .. yEH 13 24 1-613 Rev. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7b 3141 �-Jmle Gv-x— ,cls 0, 0 /,�