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FOR OFFICE USE: AMICATION FOR SANITATION PERMIT ................................. ._.. } Permit No. _7 (Canplete in Triplicate! � ......... ..... / l Dote Issued ..... .. Ilk Permit Expires I Year From mate Issued Application is 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. 549 and existing Rules and Regulationsi .......CENSUS TRACT JOB ADDRESS/LOCATION _.... ... .. _�� .........�.......W .. . ... Owner's Namet..�. ,� p —cam=........'...... . .-.. - -• ........ ....... ............. .... Address ..._.-. � city . .�� "�. fie'-0cense �,�---P�---. Phone •+ Contractor's Name ? .4cf.�. �� Installation will serve: Residence Apartment House`[] Commercial ]Trailer Court 0 Motel []Other ............................................ _....Garbage ; der '-- Lot Size ...1 y� ....... Number of living units:_..__ Number of bed ooms G :c Private Q Water Supply; Public System and name -7 ------- Character .---__ ._..----''�........... .......... ;._._..----......_..... Character of soil to a depth of 3 feet: Sand n Silt❑ Cloy p Peat Q Sandy Loam ❑ Clay Loam D Fill Material If yes,type.............. ........... Hardpan[J Adobe (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 seesewer is available within 200 feet,) Liquid Depth ......................... PACKAGE TREATMENT ( ] SEPTIC TANK I ] F(� '''"'" q Material_. No. Compartments Capacity .. Distance to nearest: Well ..Founcldtl ... Prop. Line -------------------- ` Length of each line.. . e ..--- -..... Total Len th .. ...... . LEACHING LINE j No. of Lines -------/.•._..... ng ,�� rr' " _ h 11 'D' Box .... Type Filter Material .10a. ...Depth Filter Material .1.. .......................�......-..-•. •. Foundation ..�� ....... Property Llne s `-•-••-•.••• f Distance to nearest: Well .... Riameter aL --��. Number ........... ......... ... Rock Filled Yes,[ No 0 SEEPAGE PIT l Depth ��----_ x r /V ----Rock Size .. -------• Water Table Depth ----•--- -�----------------------- � / ! Distance to nearest: Well �2 atJ• Foundation _ ! --•... Prop. Line .... --- REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .................................. Septic lank (Specify Requirements) ................. j�.... . . R .... . Disposal Field (Specify Requirements) --• ............U ` !' ................. (Draw existing and required addition on reverse side) I hereby certify that t have prepared this application and that the work with be clone M accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Hone owner or licew sed agents signature certifies the following: person in such manner "I certify that In the performance of the work for which this permit Is Issued, 1 shall not employ any pe as to become subject to Workman's Compensation laws of California." Signed ..... --- -"--- . • - :.... -•-...... Owner — aY - ------ - -------- --- ......... Jitle ------- - -• (if other than owner FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- . ......... ............ . DATE 'r BUILDING PERMIT ISSUED --_............... ..• - .._.... -- --..............DATE - -----..... .. ......................... ADDITIONAL COMMENTS - . ... ---• ................:.................. .......... _ ..._...... ...... -----_ ........... .................. . .. .. .................Date _ 7 ...... Final Inspection by: -...4,, : . . .... (� Eli 13 2!t 1-613 ;S, JOAQ IN LOCAL HEALTH DISTRICT 8/7h 3M 1