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FOR OFFICE USE.. c V �c - APPLICATION FOR SANITATION PERMIT s. '... t Permit NO. .7�?•_- 7 3 ...... �' ICamplete in Triplicate) Date Issued ---3.....°- This Permit Expires 1 Year From Date Issued "". Application is hereby made to the San Joaquin Local Health District for a permit to construct and Instal) the work herein described. This application is ,rmade in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCAT /ter 01, .---0/, ...CENSUS TRACT Owner's Name ..{- ........................................_.....................Phone Address sem- �._.. ._.. City . .............•-•------------------------ ....... .. .._ Contractor's Name ------- CIS so ........................ Phone 611 .-- Installation will serve: Restdeneef Apartment Houseo Commercial[[frailer Court 0 Motel []Other....... ................ .............. f Number of living units:...- ------ Number of bedrooms —3.....Garba Grinder . .... .._. Lot Size Water Supply: Public System and name .................................._..........e //� G ...............Private ❑ Character of soil to a depth of 3 feet: Sand 0 Sift 0 Clay 0 Peat❑ Sandy Loam p Clay Loam RL Hardpan[j Adobe K,Fill Materlal ............ 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 tank or seepage pit permitted if public sewer is available within 200 feet,] 1R PACKAGE TREATMENT [ ] SEPTIC TAMC f } Size...............................__............ Liquid Depth .................... Capacity •------------------- Type ------------------.. Material...................... No. Compartments .........._........... Z Distance to nearest: Well ....................•...._.... -_._Foundation ...................... Prop. Line ...................... M LEACHING LINE [ j No. of Lines ------------------------ Length of each line------ ----_*__.......... Total length ............................ 'D' Bax ...........- Type Filter Material ....................Depth Filter Material ............................................ Distance to nearest: Well .......----------_-- Foundation ----------- ............ Property Line ........................ SEEPAGE PIT { j Depth .................... Diameter ----------- Number .......................... Rock Filled Yes © No Q Water Table Depth ----------------------------------------------Rock Size Distance to nearest: Well ........................................foundation -----•.............. Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# . .. ----------- .I.............. Date _....._.........._ ........... Septic Tank fSpecify Requirements)q ) '-------•-`.".... .... •--------•............ .......... .........................•........................... Disposal Field�(Speci Requirements) -�°-- -- -. ._ , .••--------- ----- -----•---------- ----- ----------.--••--......... ...................................... (Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this application and that the work will be done in accordance with Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the San .Joaquin Local Health:Dl trict. Home owner or lieew sed agents signature certifies the following: "I certify that In the ormance of the work for which-this-permit Is issued, i shall not employ iny persons in such manner as to becAes- su to orkm ms's Compe ation lo_w�°f California.", ' Signed -.-. I...- - - -- -.&>-.77 � �i:�.... Owner BY ----• - title ---4c Iother than own r) FOR DEP TMEN U ON Y APPLICATION ACCEPTED BY .......... .............. .. DATE .. v16-...._...-.-...... BUILDING PERMIT ISSUED _.. DATE -... ----- •---.......--. ADDITIONAL COMMENTS ---------- �..,.................. ................................• . •-------• - ......................... ••------------ •... . Final inspection by: --- --- .--------.--Date -. --` rte-= fj ------------------- EH 3 2h 1-6f3 S JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M — r.