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`FOk OFFICE USE: - APPLICATION FOR SANITATION PERMIT, ask. . ....... ................ Permit No. .. ..7 . SO �`l7 a (Complete in Triplicate) .............. .............. 11 Date Issued ...:7'��7 px This Permit Expires t 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 ......, Q.. 5 X65_.._....... X..�e _ _.... .... ......CENSUS TRACT .... ......... Owner's Name ...... ....................... -• �.... Phone .... c .J � . ..:...... 1 ..� ._. . . yS .. City .. .. Address .._. ......... ... . .... ...... Contractor's Name .... ... ...i- . -. u. .. ��2....... .. ....... .. ..................License # ��I��fis-�... #phone Installation will servet-- Residence-*Apartment-House,EQ-Com mercial-❑Troiler Court i❑- i / Motel Other ...-... 4 G Number of'livingunits:...,...... Nun be'i bfCOand drooms __411....Garba a Ger .___....... Lot Size .................... k Water Supply: Public System and name ..................--•-._:___-- .......,...-_._,I___......-------...................--_--.. ............Private ..- Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 5 Hardpan ❑ Adobe ❑ Fill Material .....,.,..., If yes,type ... (Plot plan, showing size of lot, location of system in relation to wells, buildings etc'!I must beplaced on reverse side.) NEW INSTALLATION:( (No septic tank or seepage pit permitted if public sewer is available within f200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size... . ,X. ....... Liquid Depth ... /��... ........0 `. capacity Type �� ! Material... . ..._.. p ��. ........ Co acct w� E -.. No Com artments / I Distance to nearest: Well /........ ...Foundation ��_.�. -....... Prop. Line .�U"`'_�_...0 J LEACHING LINE No. of Lines Lengfih of each line. . / l Q ] / ._. Total Length ' . _ �.� D" BOX "/ Type Filter Mgfienal f 0-e Filter Mai rial ........ ....... `I a �`�> it Distance to nearest: Well .1C . :'-".':..:7 Fbundation Property Line ...... ................ I SEEPAGE PIT [ ) Depth 4 w__._.___Diar eteru NuRoc 4 �ber p,� � . ) . ... k Filled Yes ❑ No p j , Water Table Depth .._:..- -.. F�. 4 . .. ----..:Rock Size �f �n 1 Distance to nearest: Well ..... . .............. ...Foundation _._�.. ._.,. .._.... p. I } .Foundation . _ .................)Pro Line .................. REPAIR/ADDITION(Prev. Sanitation Permit# ._•... _...,_ . a........-.-._-.---VIDate .(,......... . .I Septic Tank (Specify Requirements) .. ..... ........ . .... ..... ----- -I ........ ................ I Disposal Field (specify Requirements) :...................A. :... .:. . . ..... ± ............. ... II _......... .... .........._......... ..... j � � 41 (Draw existing and required add it on#ori'r`eve'rse side) I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations:cii 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 which this permit is issued, 1 shall not employ any person in such manner as to become subjertoor an's Compensation laws of California." Signed .:.. :.... �. C ..... 1 Owner By ._ ......... .J......I Title . .... (If other than owner) _ FOR DEPARTMENT USE ONLY -- _ F _ ! �3 APPLICATION ACCEPTED BY 4'C/ C � l ]LDATE .> 3 7lfr BUILDING-PERM I-TISS )ED ._; ._... .... .. .....:: .. DATE . . ..,..:"'. " ADDITIONAL COMMENTS .... ............. . .... .. .......: r' "" 1� _................... 1 ,[ - - i ................................ °. -`. -- - ---... -- { .-•--------... . .. Final Ins _ t ._ -� Y - -------------------- - --- Date � Inspection b P � .... ------....-.- . ------- -- SAN JOAQUIN LOCAL :HEALTH DISTRICT 13 .241