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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .......... ............... ........... 7 ` 7 \ (Complete in Triplicate) Permit No. .................. .. ............ 4Date Issued .........4........... � � ..-- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin local Health District for a per 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/LOCATIONa.7..... z ..-•.......... ....................CENSUS TRACT ................... ...... Owner's Name .`' / ... J� :......................... .:. ............. Phone .................................... Address _._... dam,.-7 ........y�f... "-t�t1_�? f es.............. City ---. ........................................................ Contractor's Nome 1 Ge. - 'F--......License# jff ..3.4.:?- Phone .............................. Installation will serve: Residence❑Apartment House 0 Commercial QTrailer Court 0 Motel ❑Other Number of of living units:...... Number of bedrooms .. Garbage Grinder ............ lot Size .., -fir -............. Water Supply: Public System and name ..........................•-•--....-...-•.-----...-...........................................................Private Character of soil to a depth of 3 feet: Sand n .Silt❑ Clay ❑ Peat❑ Sandy Loam lay 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 placed on reverse side.) NEW INSTALLATION: (No septic tank or seep a pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ SEPTIC TANKf7Size..µ.'l�"��:.,K...` �..,X.. ....... Liquid Depth ... ..�............. Capacity JD.m.a....... Type(:?' - ..... Material... t - ..... No. Compartments ...... .......01 .i 0 Distance to nearest: Well ......._'C..4F...................Foundation .... ........ Prop. line .... .............P/ LEACHING LINE No. of Lines .....P................ Length of each line......6.P............... Total Length ..�_. .�?..�:.......... 'D' Box .. ....... Type Filter Material .....SA.......Depth Filter Material .....41. .................................� Distance to nearest: Well ........e..:......... Foundation ........1 v . Property Line ............. Y [ Depth ...... Number .... ..... Rock Filled Yes 0 No 0 Water Table Depth rzo........... ..............Rock Size ...X.............. 0 Distance to nearest: Well 1.17 Q........................Foundation ... Prop. Line ...-5. REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .................................. SepticTank (Specify Requirements) -•-•--•.............................................•----•-•-----........................................_................_................. 0 Disposal Field (Specify Requirements) ........................................................ .... •--------------------------------•-----------•----------------....----.....----•-----•-•--.......................•••........ .. .....-••- .. ------..,..............--• ... ... . ......... ..... ............. .._................_........-•-- --••----.....---•--•---•-•-•--••----•---...................---•-•--............................_.........,............................... .. (Draw 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 San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Homo owner or licem sed agents signature certifies the following: "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's Compensation laws of California." Signed .-----•............... Owner By ...... r� '1�' A- L ................ Title ..r w _.. .................... ........- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .... ......... DATE 3"�.3�..:7. BUILDING PERMIT ISSUED........................................................ .......... ................DATE ADDITIONAL COMMENTS ..........-•.....................•-•-............................._. •.•••... -----. ..... ... ..........•-- ...__....... . oe.........." ...._.._..--.... ._... ..._.� ...... ... ..... ........... ... Final ins ection b : ........ .. p Y ejw�t .i .......... ............................. ......... ...........Date ................... .. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.13 241-'68 Rev. 5M 7/723 M