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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT ....................................................... (Complete in Triplicate) Permit No. . ................ .................._........... ..._._ ................... This Permit Expires 1 Year From Date Issued Date Issued .7-:"o.. 7f 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. 544 and existing Rules and Regulations: JOB ADDRESS/LOCATION ._... -+ _ .�� ..----.C , r.-------' CENSUS TRACT Owner's Name ....... ...........f E2L ....... ..................... ...Phoney�3''. 5 ,5'`.._.. Address ., ... --. .._...... ��-s--C. !"_...__.._. City ------------------------ .. ....... Contractor's Name .._ 2. �.[� �� .License # ��. '/.�'J'J'., Phone, Installation will serve: Residence AApartment House❑ �ommercial ❑Trailer Court ll] Motel ❑ Other ...._.e . -f... �ic Number of living units:....--. ' Number of bedrooms -. ___ Garbage�Grinder . :�... '� Lot Size ...S.e�.._��-1�.._...... Water Supply: Public System and name ..... ----- - ------ -•_Q ------------------- Private ❑ Character of soil to a depth of 3 feet: Sand E❑ Silt❑ Clay ❑ Peat E] Sandy Loom ❑ Gay Loam 0 Hardpan ❑ Adobe A 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 erre arae.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT SEPTIC TANK } � /E✓'.Size----,7_.XS'__ .__��.._.�.,��_..._ Liquid Depth ..��.................... Capacity `6W 0�� TypeG Material... .za. No. Compartments Distance to nearest. Well ........Foundation .../Q.---- .._.... Prop. Line ----'-�............. LEACHING LINE X No, of Lines Length of each line ........... Total Length ...��_`�............... 'D' Box Type Filter Material _A ....Depth Filter Material .. .�....... -------- Distance to nearest: Well _ [.- Foundation `Q --------- . Property line -.4V 7................ SEEPAGE PIT ( Depth ,r�. Diameter a El.. Number . ......./............. Rock Filled Yes No Water Table Depth _-_-.- -.. �� - -------------�--.._...._..---Rock Size -- �..�_�..-------• Distance to nearest: Well .__ ..IV«4-0. ........._Foundation .-.l ..r_..... Prop. line _' _..._.. REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ............................ Septic Tank (Specify Requirements) .... ................ . . ..-------- --------•--- ...............................__. Disposal Field (Specify Requirements) ------ , - :. ...... -e-'� %E 7 .... . ................. ....w.a... I (Draw existing and required ad - dition on reverse side) r I hereby certify that I have prepared this application and that the work will Ise done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner at (iters• � sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall net employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed .:.. . .............. _........--- ....... ----- ----••---- Owner By L {If other than owner} FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .......... �. ... - -� . ..... .. ......... DATE --------------- BUILDING PERMIT ISSUED ....--- ............ r--- --•--- ------ DATE ADDITIONAL COMMENTS ................ ................ '.._. -- - ----- ................. . ... .. ...............................................................I...... .......................... ............. . ...................•........... .. ............................ __ ............._................ ----------- ...... ........- i Final Inspection by: ---- ----- ----• --• Dpte .�:. 7 = SAN JOAQUIN L CAL HEALTH, DISTRICT . ,