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► �`�'�`'`� APPLICATION ICOR SANITATION PERMIT ........ .......................................... Permit No. 7- (Comploteln Trlpficate) ' ............................................. Date issued rz A ........................... .... .. . . This Permit Expires I 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 Ordinan a No. 544 and existing Rules and Regulations: JOB ADDRESS/LOCA ION ././4/ °,�1... .. CENSUS TRACT Owner's Name. 1�` al-0h°._ .tea.., � 1 .. :..................... '............ .. ..--•--•........-..Phone Address ..1:1_�� '�.. �. .[� ' /'�. a: .. .................. ............Oily ...`, d ................................. Contractor's'Name _lea ~ ........ ...........................License # L�4¢rX :;�n. Phone .. Installation will serum stderrce artment House❑ Commercial❑Trailer Court 0 -�- `-Motel,❑Other............................................ Number of living units:--------__.- Number of bedrooms ..d-•j-........Garbage Grinder ----.--_- _ Lot Size ............................................*.%. Water Supply: Public System and name .......Private Character of soil too depth of 3 feet: Sand b Silt❑ Clay ❑ Peat❑ Sandy Loam o day Loam ❑ Hardpan❑ Adobe o Fill Materlat............If yes,type............... ............ (Plot plan,'showing size of lot, location of system In Motion to wells, buildings, etc. must be placed on reverse side.). NEW INSTALLATIONr (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size... .......................•............. ... Liquid Depth .......................... CapacityA� pe ` Material................. No. Compartments ' _._Foundation ...... Prop. Line --------------- Distance to nearest: Well ___. ....................... •------------- ..._ LEACHING LINE ( ] No. of Lines --- ,Length of each if ....� f. Total Length -2-1�-`....... 'D' Box J........ Type Filter Material Depth Filter Material ... ' '.�j........................... Distance to nearest: Well _______________________ Foundation ins ........................ Property L ........................ SEEPAGE PIT O Depth Diameter ................ Number .......... Rock Filled Yes ❑ No O. Water Table Depth ................................................Rock Size ..........----------_---------- Distance to nearest: Well ...Foundation ..:--. Prop. Line REPAIR/ADDITION(Prey. Sonitation Permit# ......._.. --------------------------------- Date ........_......_.......... .I SepticTank (Specify Requirements) ......................................... ...................................... ..................................................... Disposal Field (Specify Requirements) ................................._.............._._ •-•.............................•-------.............._.........--•--...................._..._....._......_._................--- .............. (Draw existing and required addition on reverse 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 of the San Joaquin Local Health District. Home owner eK Ilan- set!agents signature certifies the following: 'It certify that In the performance of the work for which this permit Is issued, I shall not employ any person In such anner as to become subject to Workman's Compensation laws of California." Signed ...........••----.......••--... Owner B . •••.... title ----- .............................. (lf other than owner) FOR DEPARTVIENT USE ONLY APPLICATION ACCEPTED 8Y .... ........ . . ... ................................. DATI:,�a .:f�'" f......,..::.-: BUILDING PERMIT ISSUED ..........r...... DATE .. ........................ ---- . ADDIfiI��NA,t/�C�OM� MENTS .. - ir/�..,�,r�,e e r, e1� •--..........:.... y�z�,u+:,.y�6a .r�►x y.-. ✓ .:.G f3efa .,7 4246 A A ![.A/.- ... .- ....... final Inspection by .............................. Date. ... EH 13 2h 1-60 Rev. 5m SAN JOAQUIN LOCAL HEALTH DISTRICT w 8/?h 3M