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FOR OFFICE USE APPLICATION FOR SANITATION PERMIT .................................................. Permit No. 7t!... �i�. (Complete In Triplicate) .............. Date is This Permit Exp reds Y'"r From Date Issued sued ............:.. .. Application is hereby made to the San Joaquin Local Health District for pp y q permit to construct and install the work herein described. This. application is made in compliance with County Ordinance No. 544 and existing Rules and Regulations: a JOB ADDRESS/LOCATION ...... ...........................CENSUS TRACT .......................... Owner's Name ..._... .... ....... .......... y ' ...Poe - - ' City _ l. ............................Yar a Address C6; Contractor's Name C ...........License Phone Installation will serve: Residence(f Apartment House Commercial:OTrailer Court 0 Motel®Other............ .:....:..:.......:. ....... Number of living units:---- -_:_ Number of bedrooms ....�� Garbage Grinder . Lot Size .. Water Supply: Public System and name ........ . ......... ........... .............. "...,...........:...... .Put. Character of soil to a depth of 3 feet: Sand C.] Silt 0 Clay Q Peat 0 Sandy loam 0 Clay loam Q Hardpan 0 Adobe 0 gill Material ............ If yes,type............... ............ 1" (Plot plan, showing size of lot, location of`systerin 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 240 feet,l PACKAGE TREATMENT, ( j SEPTIC TANK ,: �`Sie._.�'7:.. �:.� ...:.......:..•-- Liquid Depth ..._ .. ............. Capacity': . TypeMaterial._. �. No. Compartments . .... Distance to nearest:--Well ...Foundation 11;? Prop. Line LEACHING LINE ( No. of Lines ... ..,�,� Length of ach line.......... V........... Total Length .../.X ............. D' Box p Filter Material . ...Depth .Filter Material 4410 Distance to nearest Well •........ ........ ......Foundation......LO...�_:.... Property Line ................... SEEPAGE PIT ( l Depth ........ ..........-Di .arneter ................ Number ............................ Rock Filled Yes Q No 0 Water Table Depth ................................:...............Rock Size ..................... Distance to nearest: Well ...........`........ ....Foundation .....:: Prop. line REPAIR/ADDITION(Prev. Sanitation Permit# _._.... _.__ Date ..................................) Septic Tank (Specify Requirements) ....... } _.............. . ......... .__.......................... - } Disposal Field (Specify Requirements}.'4 w. -- f Draw exssting and regvred addition on reverse side) - ' 1 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 Son 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 ------ -- ------ - Vh-'n ------ . ...... . "` -= ....... !owner By .. ................. Title _._... (If othowner) FOR DEPARTMENT E Q LY APPLICATION ACCEPTED BY------............. -- ....... -= .......... DATE . .... :: .: BUILDING PERMIT ISSUED - -- ---- DATE . ...................................... ._. ADDITIONAL COMMENTS .-------------•... ........... . ......................... -.... ---------------------------------- -------------- ---- .....--------------...----- ................- ----------------..................... ........--............ ---------------- ... -- -- -------......_...._....------ ....•--...................---•- Final Inspection by ...---- ---- .................... ..... ........ .... Date EH J 3 2!� 1-613 ltev, SAN JOAQUII'�l. LOCAL HEALTH DI RIC T 8/7]! M I