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FOR OFFICE USE>- APPLICATION FOR SANITATION PERMIT Permit No. 7d ;I1 (Complete in Triplicate) ..................................................... k Dote Issued .. "•� 7 This Permit Expires 1 Year From Date Issued Application is hereby mad`.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: i f ' ..............T CT CATION .. .... --- ----- .. JOB ADDRESS/LO ��• 'Owner's Nome ...�� ..A-�c ._.: � .................... . .:.. ........Phone .7..4..0�7..`- .... I .......... City j ... - .. ............ Address ...... ... ..... ....... Contractor's Name ... f..al Trailer Court Phone - License # - -aZ-� } Installation will serve: € Residences Apartment House❑ Commercial ❑ ❑ Motel ❑ Other .. •. ---------_ --------------- Number 'of living units:. Number of bedrooms ----Garbage Grinder Lot SizeQ. .- = Water Supply: Public System and name ---------------- . --------..... ...... ••-• Priv e Character of sail to a depth"of 3 feet: 5aisd] ,;�Siltfl^_ Clpy _❑-��Peat❑ Sandy Loam ❑ Clay Loam ❑ Fi11-Material.=..�a.�.�#f�yes-type=.. ..--...-.._. .- (Plot plan, showing size of lot, Ibcation of system in relation to wells, buildings; etc. must be placed on reverse side.) NEW INSTALLATION: (N�o septic tank or seepage it� ermined if ub €c sewer is bvailable within 200 feet,) �, P ' P P P �' � e PACKAGE TREATMENT [ i' SEPTIC TANK j Size.___.._.._. _ mfr•- _ �... 5,..�_ s ..... Liquid Depth ...-s�. .-•.•• � I Capacity .p Type _> ._ Md er.al-.. " - No. Compartments - .............. u� 10 .01 HI. ...... Distance to neariat: Wel! Foundation;f- ....... ---- Prop. Line ... 11Q €u LEACHING LINE [ ] Nb of Lines-:t t .. _... .._. Length ofJ�ach;.line ... d ..... Total Length _. .._ 11............... D. Box ._f ."Type`,Filter Material ./, Depth Filter Material _/.c --_..-- II11 .............. p ,I`. ` �: Property Line ......- Di.�tante to nearest: Well ._x�Q-------------- Foundation ,+ P tY -� --- / SEEPAGE PIT [ ] Depth ,,-•Numbers-:�- --..t... Rock Filled Yes No ❑ Diameter ---,. w..,_ ❑ . Water Table Depth ..........................:------._.............Rock Size ----------._.- , r ( Distance to nearest:.Well ...............•--.-.._...--------------Foundation .:.. ---.....---*.:,Prop. Line ............... REPAIR/ADDITION(Prev. Sanitation Permit r# ........................ •---------"- Date ----•-------•-•-----•--•-------•--) Septic Tank (Specify Requirements) '-•--..- ................................. .Dispos61-.Field (Specify, Requirements)' ..................•"........J.. ............... --------- -------- ----------- --• . ...... ........................ ..-. ................. .. •------ ----------- ------ iK = ...�. .:...... � �... .... ......... :------- ....... ... �- "'-..�= ......... ..... r I (Drdw existing and required addition on reverse side) I hereby certify that I have prepared this application ands that the work will be..done in accordance with San Joaquin County Ordinances, Stateli�Laws, and Rules and Regulations of the San Joacluin Local,Health District, Home owner or (icen. ' sed agents signature certifies the following: "1 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." '. Signed .:.. -... . . Owner B .�==✓-ter ...... .. ....... Title (if other that, own FOR DEP . TMENT USE ONLY BY ... .. .L..... . �.� , / ... . --- ..... DATE ._ /y4 .............. APPLICATION ACCEPTED � - BUILDING PERMIT ISSUED ._.. . ... ......DATE _ .. ................ ........I......... .. i ADDITIONAL 'COMMENTSil i --------------- :... �� .. u ............................. : � Y '--- ---- -- j ............. ......... ateFinal Inspection by: ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT y 9 723K . . c 13 24