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�sAPPLICATION FOR SANITATION PERMIT .. .... . ... ... ..... (Complete in Triplicate) Permit No. a 7� 4 This Permit Expires 1 Year From Delve 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 comph ce with unt finance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCWTIO,�'Pe7,-X N77 ....CENSUS TRACT .... Owner's Name l/ I.--.,-#* � Address .............Phone ..�. ...... ..._. .. CI Contractor' --•-• Contractor's Name rn ..zs....... •�.�-��..ls�.�.�Q ........................ Phone Installation will serve: Residence0,Apartment House Commercial❑Trailer Court Cj Motel❑Other.--- Number of living units:.......(.-. Number of bedrooms .. ........GarYQ ,49ga Grinder ....:....... lot Size . ..` Water Supply: Public System and me ._... '_..12_,.V""""' .. Character of soil to a depth of 3 feet: Sand --.. slit ..'.. - fA ��..... —-,* "Prlvote❑ ❑ Silt(] Clay ❑ Peat❑ Sandy Loam- Clay Loam Hardpan ❑ Adobe ❑ Fill Material ............If yes,tylia ......................... (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 ] Size................................................ Liquid Depth Capacity •................... Type .................... Material....... . .......... No. Compartments ...................... •••--.••'•'"'•"... cooDistance to nearest: Well ------------------------------------Foundation ........•. Prop. Line 1 LEACHING LINE [ j No, of Lines �-��•�••••- """"""""""' ..... Length of each line......... . 0 -._�._. ..............'..." ...... Total Length ............................ 'D' Box ............ Type Filter Material ...Depth Filter Material Distance to nearest: Well ................. ............................................ � ..........•............. Foundation . Property Line ` .....................•- SEEPAGE PIT I D Depth ........................ -••••-.••........... Diameter Number .. Rock Filled Yea ❑ No cl Water Table Depth ............... ........Rock Size Distance to nearest. Well ...................................... ....---•-..._.-•---•--•- Prop. Line :REPAIR .................... /ADDITION(Prev. Sanitation Permit 51l` ...'".. ........ ............................................ Date Septic Tank (Specify Requirements) Disposal Field (Specify Requirements) .. .P �-�- „ ............... ............._................. ........- ........ -- .- ......•-•-••••--•---•----•-•--•---•--••.....--•-••-----•--•---------•----••-- .........., _ ..`.. ........ . 0 (Draw 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 sub)e Workman's Compensatio awe of California." Signed ,- J�-L �?.-Q Q'_M•6l- VL �o !,ZS.._. 6ia f� By ------. •---•--•-•--... . ........... Title (If other than owner) `J °�7",lM. .'`3.T"D..�'. FOR EPARTM NT USE ONLY APPLICATION ACCEPTED BY - - y BUILDING PERMIT ISSUED . _...... ---•- .......... DATE ..... ..- 3 f''......... .. ADDITIONAL COMMENTS ----------- •••......._...DATE ........ Final Inspection by:..... - ...... :...... :. .............. .................................. ......... ............................ .......... /' ........Date ... .. SAN JO) q IN LOCAL HEALTH DISTRICT