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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ,/ 'i Permit No. .747R .._... :. / ..kms.__ {Complete in Triplicate) f ..... This Permit Expires i Year From Date Issued Date Issued�`...•::1.-_.7 . `,.. Application isll'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. 544 and existing Rules and Regulations: JOB ADDRESS/LOCTION ..-��(/. -•---�.,--- 4GC�_.. � - T`, .CE US TRACT ....................... / / Owner's Name ........ . .. .............. :............ _..Phone ...f,:�a.:./ 3 Address ..-._. �h v�... - city . ... irvCl �` .. Contractor's Name .. :_.._--.. ... /� ------ --------- .......................License # .._-_ . .---....._._.._. Phone .. r ........ ,I .. . Installation will serve; Residence �Aportment House❑ Commercial ❑Trbiler Court ❑ Motel 0 Other . h /�Number of living units:.... . ..... Number of bedrooms ._:___Garbage Grinder .--......... lot Size ....._. .. , \ Water Supply:I Public System and name _._.......- ----•-----0..---•----.. ..D.............-----••------••-----.:_ Private Character of soil to a depth of 3 feet: Sand Silt f ClayPeat❑ Sandy Loam ❑ Clay Loam 0 Hardpan ❑ Adobe ❑ Fill Material ............ If yes, type ........ ........... (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.! NEW INSTALLATION: JNo septic tank or seepage pit permitted if public sewer is c 0 ble within 200 feet,) PACKAGE TREATMENT j ] SEPTIC TANKSize.-.--..�6a ! h I � � ............... _-•--- •- ... Liquid Depth .---.....---------.. _- ._.... Capacity ype h.G�' aterial............... ._ No. Compartments Distance to nearest: Well .Sa / � Prye --- -----.-f'.............Fou�n�at��_�Q_ ._.. Prop. Line .---....-------• LEACHING LINE [ ] No. of-lines -- Length of e h hne7. Total length -o .. ........ i 'D' Box ' c ._.... . ,'. Type Filter Material ______ epth Fiter Material ... Distance'to nearest: WellFoundation............ .../.___._ �U S� ! - .-�--•- ----•�.. Property line .--•--... SEEPAGE PITepth 7 Diameter ---------- Number . ---- Rock Filled Yes ❑ No [J Water Table Depth ------ ..__Rock Size .. .................... Distance to nearest: Well ........................-----------.----Foundation ......_._... ....... Prop. Line ............ REPAIR/ADDITION JPrev. Sanitation Permit# ---- ------------_----- __.... Date .......... -----• --- Septic Tank (Specify Requirements) . ....... ------------------------------------- Disposal .................•----------------.Disposal Field (Specify Requirements) ...........______--------------------.................... >I� .... _ --------------- .. -------- -------------. ---- -- . ....._._.. --------- : ;.:...... - (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and thaf the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulaflims of the San Joaquin Local Health District. Home owner or licew t sed agents signature certifies the following: f "I 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'sC mpensation laws of California." ' Signed _:.. . _'..... . ... Owner _ BY . I�. Title . .. .... lif other than owner) R DEP T T USE ONLY -- NC CEPTED BY .. . . ............. DATE ..�:I BUILDING PERMIT ISSUED .-... ......... . 7_ ..........�_ -- -- ------------ ---------- ---- ------- - ............ ----- ------- ......... ADDITIONACOMMENTS ......................... 4. .................. ........ •----._..-.---... .-- _._-_-----.--- ...- . --- •' .._---__r..--. ...__._........_,. .- ------ - .. --- P _... --- •---- ..... .............._. -----....._.._..__. -------------- Final Inspection by: -• ................. ...... .. . --•- ------..._._..Date SAN JOAQUIN LOCAL HEALTH DISTRICT