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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ,/ .................... (Complete in Triplicate) Permit No. -7Y.. I •. . •_..._ -- This Permit Expires 1 Year From bate Issued .........bate Issued 7S� f 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/LOCATION .....CENSUS TRACT Owner's Name ............. �. .................. ... v.. .....�'f _0,1............. r' Address 1'41.�J�l C�.. �._kC G�>7� Phone - • •---•------.... v Cit Contractor's Name ...-. .f. 1 l.v CF- -------------- ------ ...... - License # �. Phone ..�: :�1`�1� Installation will serve: Residence ER Apartment House❑ Commercial ❑Trailer Court ❑ I Motel ❑Other .................... i g Number of livingunits:..... .._. .. Number of bedrooms _ Garba a Grinder ........._.. Lot Size _.. .. , Water Supply; Public System and name ........,•-•---_-. ---• ............. ---_---Private Cl:Character of sail to a depth of 3 feet: Sand ' 0 Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam [] Hardpan ❑ Adobe ❑ Fill Material _......__ If yes, type ........... ......... . (Plot pian, showing size of lot, location of system in relation to wells,bildings, etc. must be placed on reverse side.) NEW INSTALLATION; (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT I I SEPTIC TANK-[ ] Size.--- ------ ------------. .............. _.. Liquid Depth .............. Capacity .. . --- Type .......-•------- Material- ......... No. Compartments Distance toa nearest: Wel! ------- _-.„----------._Foundation ..... ........ Prop. Line __.........._..._..._. LEACHING LINE [ ] No. of Lines;. . . --. ---- ._ Length of each line ....: .--. ,---•---. ._.... Total Length D' Bax .__.. ... . Type Filter Material __.-__--_.__._-_---Depth Filter Material _... -........... � SE Distance to nearest: Well _._------------- - -- Foundation Property Line PAGE PIT [ l R Depth__.___-- Diameter ---------------- Number ............._ Rock Filled Yes ❑. No {] i Water Table Depth ............. .. --•----------------•----------_Rock Size..................... r Distance to nearest: Well --------------- ........Foundation .................... Prop. Line .......�._.. REPAIR XIDDITION(Prev. Sanitation Permit# ------ Date ptic Tank (Specify Requirements) _-..... ._. . Disposal Field (Secify -Requirements) t,� , ....-- ........... P .......... --------- ....----- ...:_._ . . --------------- -----:---...._;----- --- ..... (Draw existing and required addition on reverse side) I hereby certify that I havo' prepared this-application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, -and Rulei and Regulations of the San Joaquin Local Health District. Home owner or Iicen• sed ageints signature certifies the 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-Worknian's Corn�ensation laws of California." t Signed - - Owner -...........'------;-• ..........._. . ---- Title . .... (If other-than owner - `... Y FOR DEPARTMENT USE ONLY r . ._. _ APPLICATION ACCEPTED BY .... �._ . .. ._ - -,..•,.- - ,,y._._.M._. .::_,-. .... ..:_... .. DATE ..... ' BUILDING PERMIT .ISSUED ..... ..... ...................:...:.r'..'.....- . ........... i ADDITIONAL COMMENTS ......._... DATE ......... ........... ....... . . ---••--- ........... .......... •--- .......... . ...••----- .....---•-•---•- -•- - - ---.-------- -•-- -.-. ..............•---..._......................-.----. --- ---- -Final Inspection by: . •--- ------ --- ----- ------ ----------- ------ ---- - - ----- . - - -- ..-_..__...-----••----•-----... _ ----------...................Date ; SAN JOAQUIN LOCAL HEALTH DISTRICT E.H. 13 24 1-'6R Rp.. nAA