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FOR OFFICE USE, "` w .' APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Hermit No. ...7.............. Date Issued pp this Permit Expires y Year from Date issued Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made In compliance with County Ordinance No: 549 and existing Rules and Regulations: 1 JOB ADDRESS/LOCATION .....I.T- 3_�S', •7' e- '. off!:...._I�f!-x•55-----�r .............CENSUS TRACT ..... ✓ "� Owner's Name ......w i.s._ },...:_/!rI o Y per'-----T•$:.. yy3 _ --••-- •-----......-•---------------------------------•---•-----.Phone . Address --.--- f_3.. ad f IgMesl.T PA 5;37. �� City >-/1c� ...•••--- -••----•--..... . ....................................................... Contractor's Nome -.6- 1-A. ,;�r'�'as}� f...s e7�Y........................License #407._S`�S 6 Phone✓�- •3..c/�� f Installation will serve: Residence 0 Apartment House`❑ Commercial ❑Trailer Court IMotel ❑Other --------------------------•--••-•-----•-•••• Number of living units......./_.. Number of bedrooms ......Garbage Grinder ------------ Lot Size _ --`_ . ..... ...........•-- Water Supply: Public System and name ...............................--------------------------.....................................................Private., Character of soil to a depth of 3 feet:'] Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam .0 Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ............ If yes,type ............................ (Plot plan, showing size of lot, location of. system ' relation to wells, buildings, etc, must be placed on reverse side.) I NEW INSTALLATION: (No septic tank or seep . e pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK Size............------------------.................. Liquid Depth........................ ...� — C acity IA! P.�j L Type�6Cc 4,0T Material. o/y ...... No. Compartments ..�............. � � istance to nearest: Well ....!t.0O .. .................Foundation ...tq.............. Prop. Line eja� ty LEACHING LINE [ No. of Lines .._- ---------- Length of each line....... Total Length ......... 'D' Box Type Filter Material .jA�----Depth Filter Material ...e;zD............. Distance to nearest: Well ........................ Foundation .................. Property Line ............__..........� 9 [ ) Depth _.......-.` ---__---- Diameter ................ Number ..._.._._._....._. ......... R1.ock Filled Yes ❑ No ' t SEEPAGE PIT Distance Table Depth ..................................._....._..-•-.Rock Size _-.............................. v� ' W stance to nearest; Well ........................................Foundation ._._...._.....__.... Prop. Line _....-.----------_-.- REPAIR/ADDITION(Prev. Sanitation Petmif# ............................... ........ Date _•........._.... ............... Septic Tank (Specify Requirements). ..........I........... ---------------- ............................................................u......... Disposal Field (Specify Requirements) --------------•----------------------- -----..............--•---------------------.._. ........................ ---•-----•----.--.... n ........................•------- i1 ..................................'------------------------------------ (Draw existing and required addition on reverse side) `u _ ""� I hereby certify that I 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. dome owner or licew sed agents signature certifies the following: "I 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 Workman's Compensation laws of California." Signed .....4e . ......I.. ----------- --•----- --•--•-•--••••---• Owner 1 By ............. :{7. ..................... Title (If other er) ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------J--tg'D.........................................I.....•. .._.............., DATE ..... . Z>- 75......... BUILDINGPERMIT ISSUED ................ ....-•------....•------------------------••-............---.......DATE ........................................... ADDITIONAL COMMENTS .._. ' ......................•---•. -•.._.... .....;.-•----•--•-----....------..... --•-..............._. .............................. ................................. ......... ..................... . •--.... .. ---• .. ............................... ........ ............. --••--.. .... .. _ . ---•-••----- --------- ..... ........................... Final Inspection Date ....... ....:................. .. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 1-3 241-'68 Rev. 5M 7177 3 M