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FOR OFFICE USE: t . APPLICATION FOR SANITATION PERMIT {_..__.. .... ..... .......................... .._ (Complete in Triplicate) Permit No. ..7 -K7 ( ------- ................... This Permit Expires f Year From Date Issued Date Issued ,,/.- ! 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 existing Rules and Regulations: JOB ADDRESS/LOCATION ....� G G�_...T= � c f� , ,rtJi� -• � •-•- _..CENSUS TRACT Owner's Name ------ 1117 U.�?. ...._ e .._ Phone c�S Address ....... = 1.. .Cr�� .... . 219. 2 .. ........ City Contractor's Name ........ ,. L :; -- ---------------License #>�.�;7 5_�Zphone-2,� ( Installation will serve., Residence W Apartment House❑ Commercial ❑Trailer Court 0 Motel ❑ Other .........•........ Number of living units....1._...:- Number of bedrooms •- _._._Garbage Grinder ........... Lot Size _......�� Water Supply: Public System and name --------_-----..--------------- --.......................... ...... _ Private Character of soil to a depth of 3 feet: Sand Silt E] Clay ❑ Peat[] Sandy Loam F Clay Loam ❑ f Hardpan [] Adobe ❑ Fill Material ............ If yes, type ................. ... (Plot plan, showing size of loft, location of system in relation to wells, buildings, etc, must be placed on reverse side.) i NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ SEPTIC TANK � ) Size...................--------.----•---........_... Liquid Depth ..._ .... t?1 Capacity J/elV------ Type /Z r/ Material............ ......... No. Compartments Distance to nearest: Well Cj--------- ---- -----Foundation . ....--... Prop. Line ./G"`� ! O LEACHING LINE No. of Lines Length of each line . � 1 .... ... ..fJ................ Total Length ..c�.-`�.•6...--- -- — - 'D'-Box .rr -.... Type-Filter Material-A��_y_ye_jA- -Depth--Filter-Material—. ..: ..:::."................ Distance to nearest: WelI �U.,j--•_.-.••• Foundation .. -�-�" 1 Property Line _.. . p SEEPAGE PIT [ j Depth,:-. '._.E._. Diameter ---------------- Number ....... .. . —�-- i------ Rock Filled Yes ❑ No C]� Water Table Depth ----- ---------------- Distance to nearest: Well -----•---------------- -- Rock Size _..-_-•• ------------ -Foundations -.........:..... .Prop. line ................ REPAIR/ADDITION(Prev:.Sanitation Permit# .....................•.- ..... Date _................ '- Q Septic Tank (Specify Requirements) . .........-_-_---- • - ... ............. Disposal Field (Specify Requirements)4.: 3------------------ .�. ----------.. .............. _..... .......... - '. ...._._. ng_1...---- ------------------------------------ - -......... . ....-.................' I {Draw existin' and required addition on reverse- side) ^� . I hereby certify that I have prepared-this-appliication-and rthat, the.work will lie'done done in accordance with San Joaquin County Ordinances, State laws, and;Rules and Regufations of the Sat's Joaquin local Health District. Homo owner or licen- sed agents signature certifies the foliowin ` - '- _ F "i certify that in the performance_of the work for which•this permit is issued, t shall not employ any person in such manner as to become subject to Workman's Carisperliation laws of California." 1 Signed .......... . ...... ' -- Owner By . .. .. . ........ . ..._.......! :::. •--- ----------:..--------- Title. .... . i (if other than owner[ ►,� ...._...-...'- . _ _ FOR'DEPARTMENT USE ONLY APPLICATION ACCEPTED $Y:... ... . ..... e.:..._. BUILDING PERMIT ISSUED ...`_.... ----- •- --• -- - DATE ...... . .. ADDITIONAL COMMENTS .. •-------••----_----. ._ ._,_. :...:DATE ....................... , ................ : .... -. __-- - __ - .... -- -- ---- Final Inspection by: .. ------------------------------------------------- : ....._. --------- -• - -----....................Date .........c�•----?�--�-�- �.. • -•-•------- SAN JOAQUIN LOCAL_ HEALTH DISTRICT E.`H._13 24 1--6$ Rev..5M .