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POR OFFICE USE: APPLICATION FOR SANITATION PERMIT // .....:... ....----- �-,�AA . .._. Permit No. 7�;(Complete in Triplicate)......... .................. G y -• Date Issued..-E,I..`: ... ................ ................................ This Permit Expires I Year From ata Issued Application is hereby made to the San Joaquin local Health District for a permit to construct and install the work heroin described. This a plication is M de in compliance with County Ordinance No. 549 and existing Rules and Regulationsx JOB ADDRESS/L ION .. ��:t/S/f/.Q�K��A....... .... .....(/,.. � .[�Ki. .._... NSUS TRACT ..5.7.-55 .... r.....: ......... Owner's Name ....... ..... ..............................................................................Phone .�e .r�07. ..,......, Address /.4�j��....:........ : -��f0 - i _. City .............................................. Contractor's Name ._ _ sf ............. .......license # . ��- .-3... ..�. Phone6Q'7... Installation will serve: R sidence XAportment House O Commercial OTrailer Court 0 / Motel O Other _. .......... ................. Number of living units:-. .(.--. .,� ber of bedrooms ..-.3....Garbage Grinder Lot Size •.. ............. .. Water Supply: Public System and Pome ..... ........... _........._......_.-_. ...... ...-.._...._.....:...........................................Private ] Character-of snit to a depth of 3 fej t: -Sand o -Silt O Clay o Peat 0] Sandy loom O Clay loom Hardpan O Adobe Fill Material If yes,type._ _---.. ...... -•--- �N (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) PACKAGE TREATMENT Pt SEPTIC TANK ------- Liquid Depth ....57Y.Aff......... Capacity Type Material.. r.'. No. Compartments .....:.. ......... Distance to nearest: Well /00 ....tr.............Foundation Prop. Line .. ............. LEACHING LINENo. of lines, 7!.: _ . length of each line _..:..�5 ........... Total Length ..�,.�........ ......... � � nn , Type Filter Material J�Kk.. Depth Filter Material .... - 'D' Bax ._.�� . .. .. . 8 t............... Distance to nearest: Well ...../4th..�''`-.... F --fA . --r--.......... .- SEEPAGE PIT [ j Depth _ Diameter ............ t um . . .-_ .............. Rock Filled Yes No 0 Water Table Depth ............ .. ...Rock Size ........................ Distance to nearest: Well . ......Foundatign _ . . ......z ..... .... ....... Prop. line . .............. REPAIR/ADDITION(Prev. Sonifatien.permit ., �... ...._------ ------ ••--_ °te .... .:.---------- ...:) Septic Tank (Specify Requirements) _ `�" 4(� 'F' Disposal Field (SpOC ify Requirements) _.....-..__._..._+� + C ............. ... ................ ......f.. .......... . �.:'��a-•,..:... .................. .... } ------ -- - --- -------------------- - ----- ------. .------------------ _. ----- ----- --------- � ------o Drdw existing and required addition on reversiaAWe) 1 hereby certify that I have preps this application and that the' work will be dant in accordance ...........with San Joaquin County Ordinances, Sfaii-taws, and Rules an�7i eguTaRe`ns�'o -%*San Joaquin Lecoli Health District. Herne *%Ow of Been- sod agents signature certifies the following: -` "1 certify that in the performance of the work for which this permit Is issued, 1 shall n*u9mpley any person 'uch manner as to become subject to Workman's Compensation laws of Celifemi Signed .:.. . ......_. ..._..._: Owner By _ . ... -------------- Title . 1'vc.7 "............... . If r than owner) FOR DEPARTMENT USE ONLY APPLICATION AC�EPT�EQ BY �- — . DATE a BUILDING PERMIT ISSN_:. . .. :....._BEAfiE- . . ADDITIONAL COMMENTS .. . ......... .. . ... ... .. .......... . . ........ '.....-....--..- r .. .. ---- -�- --:.. .........._ ....f. ....-- -...................... . -................. . ............ ..... j ...,........... _ .-..._..--•- ...._...----- Date ...................,... .. . .... . . . 7 Final Inspection . SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.13 241-' 8 R v,.. __ 7/72 3 M