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FOR OFFICE USE. I ...... APPLICATION;AOR—j,ANITATION PERMIT ...-. _' (Complete in Triplicate) Permit No. .:7*3::-�� _......_... Date Issued . `:d?E 73 ...... This Permit Expires 1 Year From Date Issued p• Application is hereby made to the San Joaquin Local Health District for a Permit to VCt described; This application is made in compliance with County Ordinance No. 544 and existing Rules constr and tand Regulations:l the work e1n JOB ADDRESS/LOCATION :._.....,._ ]OeG i f CENSLfS TRACT ....I.....------ . . 1. Owner's Name .......:.. .. , ... . ,- ....._. ` . ._ g Phone _.._..----•Address --......... .....• city C�Contractor's Name •--- } P.r----- ------ License # a2" ..� ._ _. Phone�,��a5w__ Installation will serve: _ Residence Apartment House 0 Commercial []Trailer Court [] Motel [❑Other:..----._...._._ a GrinderLot Size ..��,� t . •--. ....... Number of living units: .___Garbcs Number of be rooms .. - �a .��f— • -•--- ...................................................... �•�,��••••- Water Supply: Public System and name .__.., �4- --4-- ------CW ��.---....-----........... . ..... . .. - -----..Private Character of soil to a depth of 3 feet: Sand E] Silt❑ Clay E] I Peat❑ Sandy Loam [) Clay Loam Hardpan ❑ AdobeWf Fill Material If yes,type .. (Plot plan, showing size of lot, location of system in relation to welts, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: JNo septic tohk or seepage pit permitted if public sewer is available within 200 feet,] E\ f W PACKAGE TREATMENT ( ) SEPTIC TANK Size. - -•- - ��. ... ....... ..... Liquid Depth ...4............... ..... Capacity4ae' 0W�• Type '�'� �[,Materidl... hC (Ala. Compartments ' p Distance to nearest: Well :.. 1 ...Foundation .Za—'._........ Prop. Line -f.- 7Z.. LEACHING LINE No. of Lines f r f. , fJl+}ngth of each line ../.G. G.............. Total Length �••--=---'D' Box Box .__ Type Filter Material . ---Depth Filter Material '-`.f-•--•.••- a Distance to nearest: Well ... ! -I Foundationr �rl`... ....... Property Line _ .....:_......._. SEEPAGE PITDe the Diameter P c�• -.. ...---- --- -._ ..:E,Number .....� .....---------.-- Rock Filled Yes '" Na . Water Table Depth _.._..... ;7 _It------- ---------Rock Size ---------------- Distance - ----_._Distance to nearest: Well . _ �.1 .Q•, ----_ -Foundation ....�' :-'. • ----•-- Prop. Line -:!,�_..----•-•=---•-• REPAIR/ADDITION(Prev. Sanitation Permit.# -_.----------- ,---------- Date Septic Tank (Specify Requirements) ........ ......... ......._........... t r --------------------------------------------------*.......,...._. -• .......... _ Disposal Field (Specify Requirements) ..................................� ............ - ..... ---. ----------------- ........ -- ......-.1.1 (Draw existing and required addition on reverse side) t 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. Home owner or licern sed agents signature certifies the following: } t "1 certify that in the performance of the work for which this permit is issued, 1 shall not employ an as to become subiect to Workman's Compensation laws of California.' p y Y Person in such manner Signed .:.... ......... ... --- ---- Owner BY .. _ – . ..E Titled .... . . M -- - ..................... .. (If other than owner} / � -- FOR DEPARTMENT USE ONLY j4✓ ZAPPLICATION ACCEPTED By DATE .BUILDING PERMIT ISSUED !/ �� ......... ADDITIONAL COMMENTS ............. -------- DATE ._....._ ............:........ 1. --..-- ..... ... .... .._.�_ .^ -� �......._. .ti_. ..ti_ ------- ... '-Final Inspection by . ate . /...� � _... _ SAN JOAQUIN LOCAL HEALTH DISTRICT ' a I3 24 E. H. 1-'6$ Rev, 5M