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FOR OFFICE ..U.S..E: APPLICATION R SANITATION PERMIT . ..........a••....... 7s-1361 (Complete in Triplicate) Permit No ........ ................................ ....... .. � '7S L...... Date Issued ................... ................... . ..... This Permit Expires 1 Year From Date 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 Regulations: JOB ADDRESS/LOCATION ....-:S.7L/,.,2-/...Et.AQ.R:D.E-f/i9--...le7.............................CENSUS TRACT .................... .... Owner's Name .................... •�..!Q�!. .....taO.EE Phone �2—�� Address ..................................�'�!�?�.................................................. Citya�Te�c�z'Q.!:4...................'.�L Contractor's Name ................ . _ f �v. l-�H...!tZ -.- Z4. ,i 6rrAIcense # ........................ Phone � .. Installation will serve: Residence Apartment House 0 Commercial OTrailer Court 0 Motel0 Other............................................ ^ r Number of living units....1...... Number of bedrooms ...�.Gorba a Grinder .. , ......<..�.,�-t_,,�, g ....._ ... Lot Size ...„,,, Water Supply: Public System and name .........................................................„........._..........'... .private 0 Character of soil to a depth of 3 feet: Sand 0 Slit 0 Clay 0 Peat 0 Sandy Loam Char Clay Loam Pr Hardpan 0 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 seepage pit permitted if public sewer is available within 200 feet,} PACKAGE TREATMENT ( ] SEPTIC TANK f I Size................................................ Liquid Depth k1 Capacity .................... Type .................... Material...................... No. Compartments ...................... r Distance to nearest: Well ....................................Foundation ...................... Prop. Line ...................„. LEACHING LINE j ] No. of Lines ........................ Length of each line.... . Total Length .......... 1n 'D' Box ............ Type Filter Material .•..................Depth Filter Material ............................................ Distance to nearest: Well ........................ Foundation ........................ Property Line ............,....... .... SEEPAGE PIT O Depth .................... Diameter ..... Number ............................ Rock Filled Yes ❑ No I] Water Table Depth ....Rock Size Distance to nearest: Well ...........Foundation ............................. ................_... Prop. Line ........„., .„. REPAIR/ADDITION(Pmv. Sanitation Permit ........................................... Date ..............................._ .) Septic Tank (Specify Requirements) >..>.......... .... ..„...................... ._....._...:....._._.... Disposal Field (Specify Requirements) .. '�.�. .. ...... --------------------------••-----.----..........._...---............................-----•--._............,---........................_....---..............I............................. (Draw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work with be done in accordance with Sen Joaquin County Ordinances, State Laws, and Rules and Regukffions of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "1 certify that in the performance of the work for whkh this permit is issued, I shall not employ any person In such manner as to be • sub)e Workman's C mpensation laws of California.” Signed..� � .................. Owner By ....--•-•--------------- ... Title (If:other than ow.n. e.r.).......- - FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.. ........ . .......................... DATE ..-, .:..f .` . ....... BUILDING PERMIT ISSUED ................ .................._ .................................DATE ................................ . ADDITIONAL COMMENTSv G'� i'.... .R ? .... ......................................................................... ........................................ -.GZG./. G.. ...._ .. ....... ............................................................................................................................. Finan Inspection by: ..... ,�..t ............................................................. .. Date . .y .. ............ SAN JOAQUIN LOCAL HEALTH DISTRICT s