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FOR OFFICE USE: APPLICATIOIJ FOR SANITATION PERMIT Permit No. 7-7 y`�,, (Complete In Teiplka ) ... ... ....... `'.... ........................ .. .. .. ... ...... ............. This Permit Expires t Year from Dobe 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. 549 and,existing Rules and Regulotions: JOB ADDRESS/LOCATIONl..GIC-sf l............. ......... .................CENM TRACT .......................... Owner's Name ..-- ply "S/gam ...... .......... ... ............. ........ -••--------1-------- - ------------ ---------- .............._ .....City fir'==t Contractor's Name ...................... .._._......_..........._•....License* ........................ Phone .......................------ Installation will serve: Residence Q Apartment House[3 Commercial ElTrailer Court 0 Motel❑ i.............. Number of living units------------- Number of bedrooms ............Garbage Grinder ............ lot Size ----------------------.--------.---.--..---. Water Supply: Public System and name ...• ll...................................._....................................................Private Q. p d y El ST*Loam-GI Clay Loam p Character of soil to a depth of 3 feet: Sand Silt Gla peat Hardpan❑ Adobe Q Fill Matorlol............if yes,type............... ............ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed an reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 244 feet,} PACKAGE TREATMENT 17 SEPTIC TANK ` J -- /J Size.-M05'� �...� Liquid Depth -------•---------•------- , Capacity _/*?OP Type :....._.... Matertal.P�`' -...- No. Compartments ..r ...............d. Distance to nearest: Well ......./�- ...................Foundation .....lf-�/...... Prop. Line.... ��.......... LEACHING LINE [ J No. of Lines /�._ ..... Length of 9� ....Total Length W..... .... 'D' Box ........-... Type Filter Material RFs'. Depth filter Material . ............................ Distance to nearest: Well ......lv1s.......... Foundation ...% /........:..... Property LineAV................ SEEPAGE PIT t l Depth .................... Diameter Number ............................ Rack Filled Yes Q' No Q 3 �L- Water Table Depth ................................................Rack S ze ................................ Distance to nearest: Well ........................................Foundation .................... Prop. line ........._........... REPAIR/ADDITION(Prey. Sanitation Permit ... Date Septic Tank (Specify Requirements( .................. .......... .............. ............:....... .................----... ............................. Disposal Field (Specify Requirements) ----------------••-•---...........................................................•.....................--•-•-----................... ...................... -------------------------------------- ................--..........................._............................................................................................ (Draw existing and required addition on reverse side) I hereby certify that i have prepared this application and that the work will be done M accordance with Sar ,io"WW County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Hoo Qistrict. Herne owner or Neen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit Is 1swWi i shall not employ any person in such manna as to beco s b)ect man's Compensation laws of California." Signed .. .. Owner By----------- --------------•---------.. - .................................................. title ........................................................................ (if other than owner) FOR OE RTMENT USE ONLY �r APPLICATION ACCEPTED BY - DATE ....�i►�`,,T''7� BUILDING PERMIT ISSUED _ ..........._ DATE ..................................... ADDITIONAL COMMENTS r^sir •_ --------------- --- .....--•--•---•-- --...... . .............. • -•-.--....... •.--.......... .•. -- --•----------•--- . . ••----. .. .... - _. .. . ..... ............. .. . ....... .•• . •. ...... _. .......... ----- •- Final Inspection by: .... ........... ..._... _ ..� ... Date .. .: -e.. . .._.. ' EH 13 2!, Z-6f3 Nov. '"NI .. ........... �--. . N JOAQUIN LOCAL HEALTH DISTRICT 8/74 3m