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`+ FOR'dOFFICE USE: APPLICATION FOR SANITATION PERMIT ..�-_...I..,r...__......I...... ... Permit No. .75�.. 3S.-.S- (Complete in Triplicate) _.._.... Dote Issued ..3-1 c/ ................................................ ... This Permit Expires } Year From Date Issued Application is hereby made to the San Joaquin Local Hedlfh—Djstrict for a permit to construct and install the work herein described. This application ;is made in3co compliance with County Ordinance No. 549 and existing Rules and Regulations: P e ��NV o e (PQ- •1s,; G toy-:. NSU$ TRACT JOB ADDRESS/LOCATION .....__... -- .. ,.. .�. Es .. ................... _ ..... b, Owner's Name __.............. '' _.. e._..:_..........._.....-:..............,.......:...........-Phon !._...._.... 8�6-,�J z Address . 7 ._..... ........ City --- fit-t.e�d! 7`d'")........................ . ....... Of Contractor's Name --------b. ..•.License ---- Phone fInstallation will serve: Residence Apartment House❑ Commercial []Traller Court 0 Motel ❑Other ............................................ f Number of living units:._-_ _.^-_ Number of bedrooms .../.......Garbage Grinder _........... Lot Size . .� .................. \ r Water Supply.. PublicssteYAcin ......................d name ----------------••--••--•-----•--•------------•-........_.------- ._._.........._..----.Private{ Character of soil to a depth df,3 feet: Sand n . Silt❑ Clay [:1 '.Peat E] Sandy Loam E] Clay.Loam ❑ Q I! C � Hardpan V� Adobe ❑ Fill Material ............ If yes,type ..... ---_----------------- V" (Plot plan, showing size of cit, location of system in relation to wells, buildings, etc. must be placed on reverse side.) y NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) 3 •* PACKAGE TREATMENT t ] ......Liquid Depth .....................:.... [ ]: SEPTIC TANK Size....... .. :-- - Capacity .... ............ Type .............. .Material. .. -------•--• .-tNo= .Compartments ....................... Distane to nearest: Well .............- A-"..:�:: Foundd#on .w.. ............. Propline . LEACHING LINE No. of Lines ___________ ___________ Length of each line.---------------- ` .. .Total• Length .........__.... ........... Dox . -------- Type Filter Material --------------------Depth Filter Material .--.---_.----................... ------....-- Distance to nearest: Well ........................ Foundation ....__.. - Property Line ........... ......... { SEEPAGE PIT [ J Depth _--.- _--....`-.. Diameter ................ Number ............................ hock Filled Yes ❑ No 0 Water Tabl\Depth" ..Rock Size Distance to nearest: Well --.-_--------:------. .._. Prop. Line ............... k ` AIR/ADD (Prev. Sanitation'Permit# D t - Sept:c an (Specify Requirements]' .. ce..... .....:... .. _.......... ._......,.......... ,, o ' Disposal Field ISpecify Requirements) ------y-•---_--�------ ----- --•-•-• -_ ----------------------------------- -•---- --------- ; 3 - , ••---•----------- ............................................------------------ --- r - ... ---•-•--------------------•--------- -------------- --------------------------....................................................... (Draw existing and required addition on reverse side) 1 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. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work far 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." Signed ...._... . OwneAK $y ------------------ � ...-•----------••-•----• Title �........ - ...........-.. �—�-� (if other than owner] ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _•. --- .. ::_.. .. - ---------------•--. DATE ....... _ ...... BUILDING PERMIT ISSUED ............. ....DATE ......:...............•.................... ADDITIONALCOMMENTS ..........................................................................:........................................................:........................... .............................. ........................... .........•......... ............•..........................._..------- - ., ---...-------- Final Inspection by: ....:.... .•. Date ... ----------------•------ ------........_.....---•-----•---•---............-•-•-------• . .. .. :---- - SAN JOAQUIN AOCAL HEALTH DISTRICT E_ H_13 24 1.'AR Rev. 5M _ /l/72 3 m