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FOR OFFICE USE: ,t .................. APPLICATION FOR SANITATION PERMIT {Complete In Triplicate) 4 Permit No, ._7..] This Perml#Expires ? Year From Date Issued Date Issued .. ..—1 .�� s- ..- 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: f JOB ADDRESS/LOCATION .-CENSUS-TRACT Owner's Name _7;W.... // hone ............... ... L. Address . 7 5...... __i7�cllf�� ............ City ..�/e2G�/. �'r ............................ Contractor's Name . F ...............License #-4.67754-5/'2..3. Phone Installation will serve: Residence❑Apartment House 0 Commercial QTrailer Court 0 Motel ❑Other_&91244.__�-r,e„ Number of living units:----------- Number of bedrooms ............Garbage Grinder ............ Lot Size Water Supply: Public System and name ..........-....... ...Private Character of soil to a depth of 3 feet: Sand o Silt❑ Gay Q Peat❑ Sandy Loam o Clay Loam ❑ Hardpan Q Adobe Fill Material ............ if yes,type............... .....I...... (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be places) on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet] SEPTIC TANK i - [ ] f l Size__....ZS"A..�3� ---------------------- Liquid Depth .......... 46F"FILI& Capacity -------------------- Type ..---------•---_-- Material.......--------------- No. Compartments � Distance to nearest: Well .... _ 70, !" l- ` .. •--••-----•-Foundation .._/0.��`...... Prop. Line _.-450— ...-----... J LEACHING LINE [ ] No. of Lines __________________ Length of each line.._-__--.____-_----_._ .--- Total Length V Box ------------ Type Filter Material ....................Depth Filter Material ..................................... Distance to nearest: Well ........................ Foundation _...._.-_.......__...... Property Line ........................ Z SEEPAGE PIT ( ) Depth _tea--------- Diameter �....�.�.. 1 ��_. Number -------/.Q..---------- Rock Filled Yes (� No �] . Water Table Depth _.. _----------- ......-...........Rock Size ............................. r .f Distance to nearest: Well ._,1 ...... .....................Foundation ._AP........... Prop. Line .- . ............. : REPAIR/ADDITION(Prev. Sanitation Permit# _-..._......------ -- --------------------- Date .--------------. ...._---_•I Septic Tank (Specify Requirements) ........................................... ............................ Disposal Field (Specify Requirements) . . _. ..........--------- ---- --...... ....................... ....------.....�..... . --------......... ..................---- ••.---- (Draw existing and required addition on reverse side) I hereby certify that 1 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,d1Y#rict. Home owner or Been- 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 biect to Workm s's Co pensation laws of California." Signed -•-- ----------- Owner BY ----------- - --- ---------an o (I other thner} i J itls --• ...................... FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _..-C°., DATE .._ _r •-`� --_-------- BUILDING PERMIT ISSUED .............. ...... DATE - ------------------------- ----•--------•-•-•---• .---------- ADDITIONAL COMMENTS __..._..___............... ..--- •------------ --•- ......................................... ----------------------------- --•-----.. .... _ .. Final Inspection by Date .. .- .Z�° /... . --.... EH 13 2a 1-6$ Rev. M SA J QUIN LOCAL HEALTH DISTRICT / n ��ljG/G�� /��_'.(� %�'7�//�••''* �G/Jnjf'- �C,rd/��-�`!� d%1`-t� f f/dG�c�/� ,U��,I"�'.b r�?dam�� 1 T' Tom//� �;✓�3�=, u�� .��?��