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FOR OFFICx USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. .75......... _t . This Permit Expires 1 Year From Date Issued Date Issued �`�"�: .7v� Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliar with Cou Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION . ...- � _..CENSUS TRACT ...................... ............. Owner's Name ..... one .................................... Address �. .. .. City .. Contractor's Name _ q License 424 Phone' ` , - Installation will serve: ResidenceXApartment House-[] Commercial [-]Trailer Court a Motel ❑Other _.. ....... Number of living units: . .. _ Number of bedrooms ... .....Gafba a Grinde of Size Garbage ............. Water Supply: Public System and name . !l .--...�. ..Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt[) Clay ❑ Peat(] Sandy loom ❑ Clay Loam Hardpan ❑ Adobe 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 seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ } SEPTIC TANK ZX f57yt� Liquid Depth .......................... � � Sze........._.............. _. ........ . Capacity Type Material.. -.- No. Compartments ...................... Distance to nearest: Well ----..........Foundation ------- Prop. line ._ .. LEACHING LINE Ay No. of lines Length of each line _�{®..� .... Total Length _4rg `.-_........._. %P 'D' Box "0"- Type Filter Material .,,�1......Depth Filter Material ... �i . . Foundation Distance to nearest: Well �4 T ,-_.... .'. Property line ..S":�. SEEPAGE PIT �[,� Depth .7-4 . Diameter •n Number _. Rock Filled Yes ,JV No I❑ Water Table Depth _. -.! _�" .............Rock Size ..._.2 �� _ . Distance to nearest: Well .. .-l-✓• • - ........... . -- Prop. line 47-.............. REPAIR/ADDITION(Prev. Sanitation Permit# .Ca, .7S Z`/`/_-- Date ... Septic Tank (Specify Requirements) _ Disposal Field (Specify Requirements) .....--- -_!� l - 1 _ . ��..-. � p -- _ V► (Drdw 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. 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, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California.- Signed ...... alifornia."Signed .. .. _ . ..... . .................... Owner By . ._ _. title _ _. ... (If other than owner DEPARTMINT-UISE ONLY APPLICATION ACCEPTED BY25%� -- __ -- . DATE BUILDING PERMIT ISSUED .__ DATE ADDITIONAL COMMENTS -. .__-._.-. .._. . ............... ... .. - _. _ Date .. Final Inspection by. .... . __ . _ .------....._... ..:.. . __ SAN JOAQUIN LOCAL HEALTH DISTRICT 13 24 .- 7172 3 M