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FOR OFFICE USE- -APPLICATION FOR SANITATION PERMIT Permit No. ..7.5.... ' ................. '• (Complete in Triplicate) .......... ................................... �..- � n �.. _.__-r--• . Date Issued .._ .. .... this Permit Expires i Year From;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: ......�%. ..... JOB ADDRE55/LOCATION/G_ D ........ . CENSUS TRACT ..............::..:....... Owner's Name /fl��..............p. tl .................. .........Phone - .. ........ City ............................... Address - � . _..... Contractor's Name .w<Se"'�------- --e �� License #�.� 9Y-7 Phone Installation will serve: Residence ®Apartment House❑ Commercial :❑Trailer Court 0 Motel ❑Otiier .......... ............................ �, a� Number-of living units:.....1.•.• Number of,.bedrooms ._.....Garbage Grinder jYt2__ Lot Size . Water Supply: Public System and name .. :_-._._..__................................•._._._..............._.................Private C3 Character of soil to a depth of 3 feet: Sand❑ . Slit❑ Clay ❑ Peat❑ Sandy Loam C] Clay Loam ❑ Hardpan E] ;Adobe .Fill Material ------------ If yes,type ............................ (Plot plan, showing size of lot, location ofsystem in rl'tion to wells, buildings, etc. must be placed on reverse side,( NEW INSTALLATION: (No septic tank o(Iseepage pitpermitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK t J 4 "'"`-•» 5ize-----------•-•-•-------------------------------- Liquid Depth .......................... Capacity .................... Type .................... Material...................... No. Compartments ........__._._........ l Distance to nearest: Well .................:: ................Foundation ...................... Prop. Line ..-----------..-_---- .i LEACHING LINE', [ ] No. of Lines ------_-__---....._.. Length of each line.-----_------------------- Total Length ----..............---...... 'D' Box .........I., Type Filter Mate�idl ""..................Depth Filter Materia! -Z ( Y Distance to nearest: Well ............ .......__`--.......... Foundation ........................ Property Line ................ SEEPAGE PIT [ j Depth .................... Diameter :.:......_,:_--- Number ............................ Rock Filled Yes [INo [] TIN Water Table Depth -----_..........:..............•--� .........Rock Size .................. ............ Distance to nearest: Well : -•...............Foundation --------------- Prop.,Line ................ REPAIR/ADDITION(Prev. Sanitation Permit ......-..................-• -•--- Date .............................--y Septic Tank (Specify Requirements) ......... ....... -------------- .......•i-...................•...............................................•----------........ Disposal Field {Specify Requirements) ------------------t 0._�� `1.��/yam. ��1V�..... - --•- ............ p � ____427 .__ ______ 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 Health District. Monte owner or licen- 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 subject to Workman's Compensation laws of California." a Signed Owner { ••------ --- -•--- ' Title .._ Q,I Com/ .-.: If other tha wrier .* % _ r ` _ Title DEPARTMENT USE ONLY APPLICATION ACCEPTED B - ----- - ....••-•------------------••--•-•-•----•-- DATE h- r�� BUILDINGPERMIT ISSUED -- -- . •-----•... •......---•-----------••-••................•-•.........---••-••......---......•----DATE ........................................... ADDITIONALCOMMENTS .......................................................................................................----------------------------.--------------..--------•- ............... .............. •...�...... ... ... •� ..........--.........._......._...... ...._......_._.... ...................... .. .! '... • ...........__...... .. ._....._.-..._._._ _ -... -_ ._ -- .. ....... ..... ... ....... ... _•_ Final Inspection by .. _. •-•---••---- _...-•----• --•---.........I.................:....Date /.�`7..i. R _SAN JOAQUIN LOCAL HEALTH ,DISTRICT 13 24 1_'AA De„ SAA 7 'K