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FOR OFFICE USE: _. . APPLICATION FOR SANITATION PERMIT �x (Complete In Tre'01 . 7 . cote) Permit No. 7 �Q ....... ..... ................................ ...... This Permit Expires 1 Year From Date issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to constru 'and described. This application is made in compliance with County Ordinance No. 549 and existing Rules�andt t Regulaours ein JOB ADDRESS/IOCATION Owner's Name 21 ,E'd16/ �- mvp C/....:.. .. ..CENSUS TRACT .......................... ../ F�,� iV ............... . . .......................----- .......Phone ' Address ��g f .-,- ._ City �f.c,f je.,t,....... Contractor's Name .. G�Ptiel� � l ....License # .� -4 .. .............:............. �`. -...1... .... Phone -- .,�/.4 Installation will serve: Residence [J Apartment House 0 Commercial ❑Trailer Court �] tMotel ElOther 454 ? vo,a r Number of living units, . .. .., Number of bedrooms ............Garbage Grinder . :.. Lot Size .... .......... ............. 1 Character of sol! to a System and name r: ' Water Supply, Public . .. ................ . . Private (] depth of 3 feet, Sand Silt Cl i ` ❑ .Y ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ `\ Hardpan (] Adobe [:] `Fill Material ..... .. . If yes, type F (Plot plan, showing size of lot, location of esystem in relation tells, buildings, etc. must be placed on reverse side. NEW INSTALLATION: ' j (No septic tank o► seepage pit permitted if public sewer is available within 200�feet,j PACKAGE TREATMENT ( 1 SEPTIC TANK-[ Size ---- ----- ---------- -........ ......... . liquid Depth ............... --- - - ... Capacity - Type - - -- Material........ . .. .... . , p NoCom artmenfs Distance to nearest: Well fi... ..............Foundation ..... ....... ....... Prop. Line ........... (� I LEACHING LINE [ No. of Lines Length of each line1 Total length .... ...................---. 'D' Box Type Filter Material .a------------------Depth Filter Material '. Distance to nearest: Well ....................',... Foundation ......... Property Line ........................ SEEPAGE PIT --�--- Number [ ] Depth Diameter ...........:.... ......... Rack Filled Yea ❑ No ❑ � Water Table Depth ...... .........................................Rock Size Distance to nearest: Well ...................... .................Foundation _........... ....... Prop. Line .................-... REPAIR/ADDITION(Preva Sonitotion Permit# ._...... .... .. . ...... .."_ Date G j Septic Tank {Specify. Requirements}' iaOa... .T .. --•...ISP--- sa Field Requirements) ��--...S..L ............................ - ` I ................. ...... --- ......."....--. ....... ..........---.......__.... ............. ........:... (Draw existing .... .... . ........... .... and required addition on reverse side) I hereby certify that I have prepared this applications and that the work will be done in accordance with San Joaquin County Ordinances, Slate laws, and Rules and Regulations of:the San Joaquin Local Health District. Home owner or Ilcen- sed agents signature certifies the following: l "I certify that in the performance of the work for which this permit is issued i sisal( not am io an as to 6eco-MQ su lect to Workman's�Com nsation ws of California.- Signed y y p°mon in such manner Signed . .�. ......................:. Owner _. D By - a. Jitle ( f other (hon owner] }� DEPARTMENT USE ONLY APPLICATION ACCEPTED BY � BUILDING PERMIT ISSUED /X- i'" " " " DATE . /G'- ."Z: ADDITIONAL COMMENTS . . ......._ ` DATE . ........•.....•................... I _......-_. ...- .t. ...._'. ............................_.... ... ..._ ..........-......... . .... ..............._................•...,............__ ... _ _ _. ....................... u Final Inspection by: ....::.. :.. :�. -:7. 1 ' Date .. t, ............ ...--- ...... SAN JOAQUIN LOCAL, HEALTH DISTRICT t sae E-a 33 24 , sw ' e�• kik _