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FOR OFFICE USE. ..-.....-..._.._..-_...................1/._.3-C----- APPLICATION FOR SANITATION PERMITPermit No. .�-:�.�.7cf� E (Complete in Triplicate) --••-•.••------•.-.... ..Y........ .................. This Permit Expires 1 Year From Date Issued Date Issued .�:. ..�3 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This ap ication is de in com !a ce with County Ordinance No, 544 and existing Rules and Regulations: J B DDRE5s L .. . . .CENSUS TRACT h - — - '"City . _ .....- Address --_.--_-�.UrQ._.. _�_. - j Contractor's - ---- ..License #.. �� 1 Phone ;c�' t Installation will serve: Residence ❑ Apartment House'0 Commercial j firoiler Court 0 Motet 0 Other ` . 1 Number of living units:............ Number of bedrooms ............Garbage Grinder ............ Lot Size ..... _._. .--. .. f. ........ ' Water Supply: Public System and name ........................... *. ..Private ---------------•-•---•----•---••------ ---- -Character of soil to a depth of 3 feet; Sand E] _. Silt[_ Clay [j Peat❑ Sandy Loam M., Clay Loam 0 i ' Hardpan E] Adobe .E] Fill Material ............ If yes,type ------------u--------•--.._.. i (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse i0de.1- t4EW INSTALLATION: {No septic tank or seepage pit permitted if public sewer is availablewithin 20O feet,) PACKAGE TREATMENT ' E SEPTIC TANK) ] f"gyp Sixe..... �?-• -- rlr..�...... Liquid Depth ..... `�� i Capacity 9.86).Q....-._f Type' -- ......... Material `No. Compartments ........... U) ' Distance to nearest: Well -`----.---•---..Foundation prop. Line •�`_ :. . � � � Q•Q•- ..�.��_._.-.-.. ._.�,�.��........ LEACHING LINE ( No. of Lines .._...-.1�1_........::= Length of each line----/..Q_ ..-•........ Total Length ... ....... 'D' Box ...I....... Type Filter Material ......_.........Depth Filter Material ........ ....... .............. Distance to nearest- Well - Q.�.._/�'�Foundation ...lat�....r.. Property Line .lt�!'� ` SEEPAGE PIT Depth --- -c ___.___ Diameter t �6.:._.. Number __..__.... ------................. Rock Filled Yes No fl Water Table Depth - Rock Size ............. �= -- 1 Distance to nearest: Well ...... _<�� .___..............Foundation / rProp.Line ,REPAIR/ADDITION IPrev. Sanitation Permit# .......•--------------- ------•-- -- Date .............................. .�. Septic Tank (Specify Requirements} -� QQ ,�_ _ _ .. _ ._ .�,., i---�` f ------- Disposal Field (Specify Requirements} .--- d ... ............... ....... f!IZ _.. ':. r� -. I . ..........................._ -----------------------_..................__ _ i ______ _ ------------------------- ....... ..___._�_.... ....... . .............. 5 # (Draw existing and req uired-additi.on_on-'reverse-side)--'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 ai to become subject to Workman's\Compensation laws of California." Signed .............................. ^- ... ..-•3°----`-.......................................... Owner ........ title .......Z'-/d (If other than owner) !�..��k-� - ,.�,�,.................. ARTMENT USE ONLY APPLICATION ACCEPTED BY ..._- _______ ___ _ DATE ...... .. BUILDING PERMIT ISSUED _...__ -•-• --- . ............. . .. .............DATE ....... _--��-. -------•�... ADDITI NAL COMMENTS .-;-- -- -•--• •.... ... ._ ....----••--.....------.....••.. .............. - -- •• --- 3 ----••. r ........................................•...............-................ ............... ................. . --- ...-.• -------f---.._... .- •---- --...: .................................................................................,...................------•---••.. ................. .. Final inspection by: Date ... 4 <. AQUI :'LOCAL HEALTHµ DISTRICT _. ] E_ I-f_1.3 24 1_'AA Rev �iAA ��/-Yq 7