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r �,FOR,OFFICE.PSE. `._......,_.`__..._ ............... J4.. APPLICATION FOR SANITATION PERMIT f p Triplicate) Permit leo. 7 (Complete .................... .............................. Date Permit Expires T Year From Date.Issued Date Issued ..s` ....... 7� Application is hereby made to the San Joaquin Local Health District fora UZe�--1 Z permit to construct and Install the work herein described. This applicotion.is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB—ADDRESS/LOCATION ._..-. tJi /�lQ7 ..... ......CENSUS TRACT ... Owner's Name /Q_ '..__. � C9I�_I'i ,8!�. �rYl .r`' ` . ...Phone S7?; 77../f.......... Address _3404.-c-------•-_--- ............. Ci Contractor's Name -,��_G_-- �ef.�A/ �Z_.. =q�e ..........License # Q�'�Jl. qPhone Installation will serve: Residence[]ApartmentHouse Commercial*aller Court ] Motel Q Other.................:. Number of living uniits_____________ Number of bedrooms ---.._._--..Garbage Grinder Lot Size Water Supply: Public System and name _..................---------..............................................._... Private Q Character of soil to a depth of 3 feet: Sand Silt 0 Clay Cl Peat❑ Sandy loam ❑ Clay Loam ❑ �� r Hardpan Adobe o Fill Material ............. if yes,type .............. ............ i a � (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side! NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,] I PACKAGE TREATMENT [ ] SEPTIC TAMC l Size_...................... ...................... Liquid Depth ..................... Capacity __---.---- --------- Type .-_-- Material-------------------- No. Compartments th Distance to nearest: Well .................... Foundation .............. Prop. Line ................. LEACHING LINE [ ] No. of lines ..................... length of each line................. Total Length . 'D' Bax ............ Type Filter Material ....................Depth .Filter Material ... . -..................................... Distance to nearest: Well ........................ Foundation ........................ Property Line ....................... SEEPAGE PIT [ ] Depth --------------••••- - Diameter --_- Number -------------------------- Rock Filled Yea © No Water Table :Depth ..................------------------_---_-Rock Size ................................ Distance to nearest: Well ....................... Foundation .................... Prop. Line ....::........._.. . . REPAIR/ADDITION(Prev. Sanitation Permit# _--_-----------_---_----............. Date ..........._.... � Septic Tank (Specify Requirements) ........................ . .....---•---••----•-•-------•-•-- Disposal Field (Specify Requirements) ----4-or/�7--4`'_ _....... .......... r ..........:....... ........ -- ---------------..................... -- F raw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with So n Joaquin County Ordinances, State Laws, and Rules and Regulations of the San .Joaquin Local Health:District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person In such manner as to become subject to Workman's Compensation laws of California." Sign i .................................................... Owner (If o#her than owner) ------ - -----•---- i • •. APPLICATION ACCEPTED BY .. ._... FOR D TMENT USE ONLY - ---------------• -----. DATE 77`7� , . .. ,CBUILDING PERMIT ISSUED __.ADDITIONAL COMMENTS __ . ...............DATE . -------- r------- _ ----- ------ - Final Inspection by: _ _- ------..... 1sr , -------------•----.- Date ..... ~- �. EH 13 2]J 1-6f3 -------- ._ __ . . SAN JOAQUIN LOCAL HEALTH DISTRICT � -