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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ..7`�.�•�� ....... ........................... ........ _ (Complete in Triplicate) p Date Issued . 9 7 •• `,�,'" This Permit Expires 1 Year From Date Issued Application is hereby made to the San !lance with Countyn Joaquin Local th Distr it to construct and described. This application is made p Ordinance Nominstall ein 549 and existing Rvlesand Regulat onss comp . � 3 ......CE US TRACT .......................... LOC N .. JOB ADDRESS/ a' ..r .:'.. ................ ,,. �l ....... �, ,_�✓ .........Phone .......... Owner's Na _.� Y.. ....... ....... / Q J. .t . Address Poe ...... .......... ... �'..� � �... . •. .. .............License # -� - Contractor's Name .... .,r ,�± - /-..... ... Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court I_] Motel ❑Other ........................... .�`..., . Number of Living units:...... Number of bedrooms ..-:!.••Garbage Grinder ............ Lot Size .................. ......Privatrival .......... e. ......... . Water Supply: Public System and name ......................................................... ... Character of soil to a depth of 3 feet: Sand D ilt❑ Clay ❑ Peat❑ Sandy Loom ❑ Clay loam Hardpan Adobe 0 Fill Material ............ If yes,type . (Plot plan, showing size of lot, location. of system In relation to wells, buildings, etc, must be placefe t reverse side.) NEW INSTALLATION: (No septic tank or seep a pit permitted if�ublic sewer is available within 200 ,I , PACKAGE TREATMENT [ ] SEPTICTANKi Size.. . . .. '...!'.. ............... Liquid Depth ....:�................. r�.4pa Type( .:..... Materia�`�:'..... -• No. Compartments ...................... Capacity °/ V � ..Foundation /.�........••. Prop. Line .....�`•............... w Distance to nearest.• Well "" ' LEACHING LINE [ No. of Lines .... Length of each (ine.._....'�a.�••.-•••--•• Total Length ..�-�:a.•••••••••...•-• `--� .Deth Filter Material .....If.................................. D' Box _. Type Filter Material ..... T4•-•-• p a1 .. Foundation "-C Distance to nearest: Well "" ...`.0......_._... Property line .. ............. ��.`. Number .... .. Rock Filled Yes ar irl [ Depth Diameter ... ............... SEEPAGE PIT "' � Water Table Depth .. ../..Q.Q..........................Rock Size ..... ...... A Distance to nearest: Well ......... .. p Q.......................Foundation ....°.... Prop. Line ...................... ....................) r' REPAIR/ADDITION(Prov. Sanitation Permit# ............................................ Date .............. p Septiclank (Specify Requirements) .....-----.•-•••••_ ............................................................................••-----..............••..........................._............................... Disposal Field (Specify Requirements) ......................... ..............................•••......._ 0 ........ ....... ... • . -• ............. ...._ ............................... ............................... . ........._...._.. (Draw existing.. and required addi..tion on reverse side) I hereby certify that 1 have prepared this application and that the work will be done in accordance with San 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: in such manner "1 certify that in the performance of the work for which this permit is issued, I shall not employ any person as to become subject to Workma ' Compensation laws of California." Signed ................... Owner 9 -------------•--•--...--••-..... .. ay ;/ ��,r �,rc- ...... Title ....�-��:� ........ . ..................ey.............. (If other than owner) FOR DEPARTMENT USE ONLY .................._... APPLICATION ACCEPTED BY .......... .: ..................................................................................... DATE........ ...f...DATE ........... ........................................... BUILDING PERMIT ISSUED ADDITIONAL COMMENTS ...fa .�®-••••••--•- ................................................�............... ............ ..................................................................................................... :. ............................••--• .............................. ......... .....................................Date........... /.!•. ........... ..... M Final Inspection by: .............. .....�........-•--......... ,, SAN JOAQUIN LOCAL HEA4TH DISTRICT 7/723M 13 24,_��n Rau. 5M