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APPLICATION FOR SANITATION P - 4FOR OFFICE USE: ERMIT 75--<f7/ Permit No. ... ................. :................................................ {Complete in Triplicate) Date Issued .................... This Permit Expires 1 Year From Date Issued l the work Application is hereby mode to the San Joaquin com lian ecal Health District na a No, 549 and existing Rulesit to constructtalnd Regulat ions- compliance described. This application is made!in q JOB ADDRESS/LOCATI?v .... .. 9 1 CENSUS TR � i�..� .: ..Phone . =. . •� Owners Name ...._--'----- •.�'. . .'. ....._.. - 72.�::............. Cit .----..... Y Address .............------'tt - � -�' � I� .r._. .t_.f:T...�IL Aicense # .- Phone ".._..... Contractor's Name .. ::. 1� -. -•.... r Installation will serve: Residence KApartment House Commercial []Trailer Court C] Motel El Other ...... -'-- • ..... ---- Number of living units:.]......_ Number of bedrooms----•--Garbage Grinder .._.._..._._._ Lot Size .��- F�C,CLte Water Supply: Public System and name ............ ------------------------------- . . Private E t .._..--"❑ ❑ El Y Clay loam Character of soil to a depth of 3 feet: Sand Silt ClayPeatSand loam ❑ y Hardpan Adobe ❑ Fill 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: INo septic lank or seepage pit permitted if public sewer is available within 200 feet,) Liquid Depth .... ..................:.. PACKAGE TREATMENT [ I SEPTIC TANK f ] Size.------ q P Capacity Type '- Material ------- .... No. Compartments ---------------- J Foundation Prop. Line ................. Distance to nearest: Well Q 1 . De Total Length LEACHING LINE [ 3 4 No. of Lines .. ,� � 9 ... �:.] 1Len th o each ane...'Depth Filter Material '. ....-' - --- -•'------•-• -------•-•----• k f I 'D' Box - . . Type Filter Material p • ----- ---- Foundation ............ ' Property ,Line ....--- •..............rn - Distance to nearest: Well __....._- _._ �-- Depth Diameter Number . ...... .... .. Rock Filled Yes ❑ No ❑• SEEPAGE PIT { ] Water Table Depth. ._........ .............. Rock Size , ' Pro tine _...----_---------- Distance t I nearest: Well ._;.._-.--_._ . ------------------Foundation ............ .. ... p � REPAIR/ADDITION IPrev. Sanitation Permit# ........ .---.-- • 'Date ------------------- fl! A . ... +l' ------. Septic Tank ISpecify Requirements) ...A--- I. -e-....." ' _ �• i� , Disposal Field (Sp Requirements) - '�iJ...... . IDrdw existing and requir d a Ilion on reverse side) I hereby certify that I have prepared this application and that the work will be dome in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Hovlth District. Home owner or licen- sed agents signature certifies the following: person in such manner "I certify that in the performance of the work For which this permit is issued, 1 shall not employ any 1 as to become subject orkman's Compen tion laws of California." }} 1 Signe ,jl.. .` t.. i'4 2: L '.FI.�E �'?s -- <- "B�rne+` �,✓ .,/.J. Title , ............... Ilf other than owner) 1 FOR DEPARTMENT USE ONLY ` APPLICATION ACCEPTED BY . ..................... DATE ...G .....Y---..........---...---- i ... - ...-- • -'-- •---- -- ---._-.._.. BUILDING PERMIT ISSUED ....... � ' _.. --- -----.. . . ....... .....DATE " . -- -----• -------= -------'--•..._._. ADDITIONAL COMMENTS _....�7/0......Y�-r .�fC.". _ _ -. :................. r' . -- _ -- .... j�' " ' _..__ _ --- ----_------------------ - . - -------._ -.. ---- -------------- .....---Date........... Final Inspection b ------------ SAN ..z..... = JOAQUIN LOCAL HEALTH DISTRICT ` _ a 7/723 ,4 .tee n_.. tai __ -