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I i i FOR OFFICE USE: APPLICATION4OR SANITATION PERMIT .............•------........::. Permit No. .7 . (Complete in Triplicate) - � ' '................... aa This Permit Expires ] Year From Date Issued 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. 544nd a fisting Rules and Regulations: .....r-u.. �L-. CENSUS TRACT ......JOB ADDRESS LOCATION ........ 3 . ....... Owner's Name ,T�'4r!'� .. Phone 6 Address ............. ........... City ---•----..-.'... . . ....................... Contractor's Name .-.-. i.. .�.:. 1 .! !s✓. --------------•--•-•-----.......License # ------- Phone F.41.7::�4' .. Installation will serve: Residence M Apartment House❑ Commercial ❑Traller Court 0 Motel ❑Other .............................. ........... Number of living units:...------- Number-of bedrooms -- -_---Garbage Grinder .......-.... Lot Size -- Lac.. /(?'.`' ............... Water Supply: Public Syi stem and name ..... -------------------------------------------- ........ ....... --------------------------- ---:_.............Private ❑ Character of soil to a depth of 3 feet- Sa._nd,. Silt❑ _—Clay.E)_,-..Peat_n_" S a"n L clyjqqmTo Ci.ay Loam_❑., .- _ . Hardpan❑ Adobe ❑ Fill Material -----------. If yes,type ------`-------------------- ,�� r j (Plot plan, showing size of lot, location of system in.relotion to.Veiis,{s buildings, etc. must be placed on reverse side.} NEW INSTALLATION: i(No septic tank or seepa pit permitted if public sewer is available within 200 feet,j i PACKAGE TREATMENT t[ ] SEPTIC TANK [* Size........: ....:'!=-....1_. -...... - .- .. -_. Liquid Depth ........... .............. ;Capacity ./3` Q-._-:-.Type- _-- Mater ia6 .._N ,Compartments ...................... Distance to nearest. Well _"5 .............. .....:..Foundation ..10 • . Prop. Line . LEACHING LINE [V""No. of Lines ...3--1_........... Length of ecicl line --. -,,:. Total'Length ... .1.4.x.......... �� DD O i'D' Bo Type Filter Material ... Depth Filter Material ...... ./� 1/0 r E .../.l��.........._. Foundation . Distance to nearest:'Well .l1. • ...... Property Line fid. SEEPAGE PIT [ j Depth ......... .......... •Diameter ................ Number moi- --: ...._. ...... Rock Filled Yes ❑ No T Water Table Depth ni. . ' ' t.___...-.Rock'Size _..._... i r F Distance to nearest: Well ...--....................................Fo4ndation .................. Prop.Prop. Line ...................... REPAIR/ADDITION(Prev.:Sanitation Permit# ...... ...................................... Date..................................t} Septic Tank (Specify Requirements) .............. --------- .......... ......... ............................................:........_•---......... I f Disposal Field (Specify Requirements) .--••........................ •--- ... S ' --•--_..... -------------------------------------•-------------------------------------------------- : r �- - -; -------------- --•--. ......... •-.................. (Draw existing and required addition omreverse-sldej 1 hereby certify that I have prepared this application and that .the work w01-be-_done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin LocalWillth District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this 410ormit is issued, I shall not employ any person in such manner as to becantj.,ec to Workma 's Compensation laws of California.";5igned,k-et . ---- _..........!! -- Owiner ' BY -• ----.......... ...................... ------•-•-••----• .............. Title'.= ...................................... (If other than ownerj � _ FOR DEPARTMENT USE ONLY '4 APPLICATION ACCEPTED 8Y .......... ... =..... -----------• .............. .... DATE -•- � . BUILDINGPERMIT ISSUED ........................••-•-.---•--=.....•--•-•--••-------.._.-.-.--._...-----• ...:.....:.-.... DATE ---------- •...._..................... ADDITIONAL COMMENTS ............................................:........ :..... ._.......-...................__...................-.. ---....-•-•---------------............................. - . .......................... Final inspection by: ......:............ -. ...... ,..-_--•-...:-...----------------------------.-.Date ..�r.l:- .... -. .... .——SAN,JOAOUIN LOCAL HEALTH,DISTRICT _ 3 E--"H--13 24,t_'AA-RpV