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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Triplicate) 7S ~ -77Y. _...........___.._....................................... r� This PermlitExpires t Year From Date Issued Date Issued °" ...:r i 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 .._.2�1. .............�Sr----...._ �. - ................ T....CENSUS TRA�C/T.� Owner's Name ....M11-Aw 4-e-� :.--------- 9_11-1,1 .........................................................Phone ..7/ ..... ... V �.� _._..._ L•J'..__ 1 / ....__.cS �city ... . ..........✓...... ............... Address Contractor's Name _..... 771-71�--------- - . .............License # dZrVV 7wX Phone 3 Installation will.serve: ResidenceA Apartment House Commercial❑Trailer Court �] I Motel ❑Other--"-•------•--- ....... --_----------_--- f , Number of living units:.-;k---- Number of bedrooms .....Garbage Grinder ....... .... Lot Size --J ---X•J�Q Wester Supply: Public System and name .................. .Private ❑ Character of soil.to a depth of 3 feet- Sand❑ Silt 0 Clay ❑ Peat❑ Sandy Loam 0. Clay Loam ❑ }„Hardpan ❑ Adobe XFill Material ............if yes,type............... ............ (plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic:tonic or seepage pit ,permitted If public sewer is available within 200 feet,) PACKAGE TREATMENT f ] SEPTIC TANK I ] Size........................................... Liquid De th Capacity €� Type .. Material...................... No. Compartments Distance. to nearest: Well ....................................Foundation .---------------...... Prop. Line .........._........... LEACHING LINE No. of Ling+s _.._._._.�...._...--"" length of each line..........G4--.......... Total Length .------2S ...---•-- ti D' Box ..�r.�-.MType filter Material s_ Depth .Filter Material -------1.66-1 .............••--.•..•-•• ; Distance t 6 nearest: Well .. D.N.. __. Foundation ------/ ------=---- Property Line .....X!............. SEEPAGE PIT �[�]” Depth ..... ........ Diameter10 �... Number .......... ............... Rock Filled Yea. No (3 ' I" Water Table Depth ------------_6.4p ................Rock Size ------ ............. � Distance to nearest: Well ... V .�,�......................foundation ._.��.�..__ Prop. Line .... ................Q k REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----•--- _ ) k � � Septic Tank (Specify Requirements) . .............. . -----..............""-•-.._..-•••_.-------.._............_._....-••---.........--•--•---•"••--........ i Disposal field (Specify Requirements) --------------------------------------------------------- _------------------------_- ------------------------------------- ...... i t ---------------------------------------------------------------------••-----=----------------- ............-----•---•---------------------._._-•........................................................ !I(Draw existing and required addition on reverse side) I hereby certify that l have prepa�W 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. Horne owner or liten- i sed agents signature certifies the following: "1,certify that in the performance of the work for"which this permit is issued, 1 shall not employ any person in such manner as to become subject to Wor cman'; Compensation laws of California." € Signed ...... - ------- . . --- Owner BY ------------ Title -----_----_---- ----•- •....---".................................. (If other than owner) FOR DEPARTMENT USE ONLY �. APPLICATION ACCEPTED BY _..---�.-' -. ----- - ----------------------------------------------------- - ------------ DATE . .LCI- ./. ...............: BUILDING PERMIT ISSUED ...--"-----`.'- ------ DATE .......... t . ADDITIONAL COMMENTS .---------.- 1-----••---------------------- -------- ..................................... ................ ..............:........................... l, s _ ..-"-"...........................""-""-... r --_._... -•-•__....---"'_..I—...._.__._. __........... .----"-..... ....__.___.......-----------. _ ............................. --------- -------- I Final Inspection b ---Date -. ..�_. .................. ' " EH 13 24 1-68 Rev. 514 � S N fOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M