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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ...: ........ Permit---•- Permit No: ..7�.P�� -- (Complete in Triplicate) ... This Permit Expires 1 Year From Cate Issued Date issued . ..........:..... ..........................1........ 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 a v��g Rules and Regulations: 1� �eLk'I�O►3'iENSUS 7itAC'i ............... .......... JOB ADDRESS/LOC ON ...... ..._...._ .. _ Name ....__.Phone Owner's . ... -•-•- •. .................................. 0 ....l11 ...---•----• . City n r '.rzZ.. ......_ (r........... Address ............... 4. f" ff It- Phone :64 Contractor's Name ...... Commercial ---.License #� _ .y .. Installation will serve: Residence ❑Apartment House❑ Commercial ❑Trailer Court --------------------•-------.-•-----•- . Motel []Other .:__.. Number of living ..._.._ Lot Size --X.�G�•X• `f� ..-•-•-- g.�units::..;.-rof�bedrooms .Y-•..Garbage Gander .,__�4 . . ...Private ❑ Water Supply.- Public System and name_:,............•. � "'' ( .. P to k 1. Character of soil to a depth of,3 feet; Sand 0~.Silt-ED CM [-�- Peat D Sandy Loam Clay loam Hardpan ❑ Adobe ❑ Fill Material k z.....::__ I#yes)type ............................ TA (Plot plan, showing size of Iat, location of. system in relation to wells, buildings, etc. must be placed on reverse .side.) see a.ge pit—pitubliic sewer is available within 200 feet) NEW INSTALLATION- (No septic tank or {r PACKAGE TREATMENT [ ] '� (f&7f SEPTIC TANK Size....... 1�. ..--••••••; I.. Liquid Depth,.--• ............... I M r—Type ... __ Mater1aI... w-•.. NdCompartments Copa ity f ._. f Dist6Mnce to nearest:.Well .................Foundafion ..._i!.4 :.. ...- . Prop. Line ... ---:.._----. r / , � r g .... _. ....:._. LEACHING LINE �4 No. sof Lines -------- -----... Length a eq line.--_..... ..-�......... . Total Length .-•.... f �I Material Depth Filter Material ----.. .._...-•-- . 'D Box .._._ -••--•---•--- , ) /� Type Filter �••• - , Yp "'Distace'toLorest: Well"'.,....' •• Foundation ..l-a....-. •-• Property Line . SEEPAGE PIT [ ) p Diameter .__ ...k'._ - Number ............. ....... ------ Rode filled Yes No >D ` Water Table Depth11 .............Rock Size :..X_ a---------- Water -•-----••---•-........_ I it Distaince to nearest: Well ..��•-•••••--••• ...... Foundation .-1�:... ..... Prop. Line .. _ ....... iI _ . 1 REPAIR/ (Prev. Sanitation Permit# .......... .............. �' ` ........ Date .....--......._..........---••- -- rt- Septic Tank (Specify Requi a encs) - . .....••. ..................................._........-----•----•-......................_..- - i Disposal Field )Specify Requirements) ---•------------------------------ -------- ..............................._.--------------------------------------------------------- I l __.....,, °- --- (i]raw.existing and required addition on revbrse side) h San Joaquin, I hereby certify that I have prepared this application and that the work will be done in accordance wit County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: t "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't4 y3 ' d r Signed �:.. .. . Owner g ----------- ---------- t_ BY ......... . Title __.--__ . -- (I of r hon ' wner) FOR ART ENT USE ON Y APPLICATION ACCEPTED B. F BUILDING PERMIT ISSUED .r DATE ....................::. ---.-••--- . ADDITIONAL COMMENTp1S�!�-- . •�f •-- •- ...-----• ••--- ..... -•--• -----....• ................ .. ................................. - y- -... '" •--..... S. ................................ , � � Date .. .•-.-••-- i Final Inspection by t................... SAN.JOAQUIN,LOCAL HEALTH DISTRICT; 13 24 t -,&fl oma..