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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ......................................................... Permit No. 7!(/d 3y [Co`rfrglete in Tripllcatol _. This Permit Expires 1 Year From Date 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 Regulations: JOB ADDRESS/LOCATIO C�" .... .......CENSUS TRACT Owner's Name ....Phone .. '.. .... ...:.. ....... C1/�h 1 Address ... --.-•--.-----••. -- ��..... _ ................City ... l._../... /,, Contractor's Nome ................... •-....... ..4rt - ..d.1ri* __..........._.....License ##.L> ... Phone Installation will serve: Residence Apartment House Commercial❑Trailer Court El Motel ❑Other f Number of livingunits•....1 Number of bedroorins Garbage Grinder ' .-._ Lot Size ...... ............................. ....... Water Supply: Public System and name ....:..........•---..............................------......... ..........:...._..._..........................Private I Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay [3Peat[3 Sandy Loom❑ Clay Loam ❑ Hardpan 0 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 tank or seepage pit permltted if public sewer is available within 200 feet,) PACKAGE TREATMENT SEPTIC TANK .. Liquid Depth .�.,. ,�. [ � � ] � , Size...... _.......----•........... ....... ................... ... ...... .:.. .... Capacity ................... Type ...:................ Material...................... No. Compartments -----................. Distance. to nearest: Well .................... .... ................ Prop. Line _..._..,_...:......... LEACHING LINE C I No. of Lines�l_______________•_..... length of each line............... D' Box Type Filter Material _.Depth .Filter Material .................. Distance to nearest: Well ........................ Foundation ......._.._..-- -_... Property Line ...__- 1. i SEEPAGE PIT [ I Depth Diameter ................ Number ........ Rock Filled Yes ❑ No Water Table Depth ................................................Rock Size ........... Distance to nearest: Well ........................................Foundation .....................Prop. Line ...................... I REPAIR/ADDITION[Prev. Sanitation Permit# Date . .........:... } -- Septic Tank (Specify Requirements) ....... J.. ... _ ... ................... '3 `� �J� Disposal Field (5pedfy Requirements) _..a....-•--------•-------••..........-•----•---------------•--------------- ----------- ----------------------- ------------------------------------- ----•--•----•---•--====-----•••-- ................................................... (Draw existing and required addition on reverse side) 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 Son Joaquin Local Health;Dlstrict. Horne owner or licen- sed agents signature certifiei-tlte following: "I certify that in the performance of the work for which this permit Is issued, I shall not employ any person In such manner as .to become subject to Workman's Cornpensatlon laws of California.',' Signed ---- ------------------- - - Owner By _.. Ilf o---a.-th"er lytha` oner! - • ...........•--._.......... Title........ .............• ----------------- ----• , FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -..--,, - _.. DATE /.2— �:` '.7.6 = BUILDINGPERMIT ISSUED ------- ............................................. -----------.---- :--------------DATE ................._........--............... ADDITIONAL COMMENTS --- •-----•---- ---------- ---- ----- ----- - •------------- -------- .............. ............................... ----- ....._._..._...•--•----...-•---------------._...:----------•---- --------................ r •--•-- -•-- . ..---------... ............ _. ----••-_------- / Final Inspection by: __e ---- --.-•--------------------- ----•• ............--.....Date - �" ----;Z7._-•.._.... ....--._ i � �.3 2!t 1-613 lLev. � a. ---... .....- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 8/711 3M - I