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} FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 3 �"'�..... Permit No. 7 ._...... ....... ........................-.- � .. .� (Complete in Triplicate) � 6= P Date Issued .............. ..... 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 in-stall the work herein p........ ...........I..... ..- k with County Ordinance No, 544 and existing Rules and Regulations: described. This application is made in compliance ......................CENSUS TRACT .:.......:....:..:::-... JOB ADDRESS/LOCATION .......-_ e . .. Owner's-Name ._...._.... ... . Ce_lv. .�SlJ.�.l-. � .__. . . City .. �� ...Address ..,� L'cense #a�_]/,,j..r�_ ... Phone ....---••Contractor's Name ..... ........ .... Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Court 0 Motel ❑Other .........................-.:7............. a ll Garba,e Grinder �-Q.__. Lot Size / - .... �................ I Number of living .units:......r_.., Number of bed s g Privatd - u. .... .................. // . Water Supply: Public System and name ......... .... . /h : - { `'` � p - — Sand Loam ❑ Clay Loom �] Character of soil to a depth of 3 feet: Sand 0. Silt❑ Clay Y Hardpan ❑ Adobe' I Material ._� 1f yes,type ------------ --------------- Ian, showing size of lot, location of. system in relation to wells,.buildings, etc. must be placed on reverse side.) (Plot p , F NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) Size...._ ... Liquid Depth _.... ...........--- . . ,PACKAGE TREATMENT [ ] SEPTIC TANK t ] p ......................y Capacity ._ Type ..-----•-•-••....... -----Material---. •---- No. Compartments Distance to nearest: Well ...Foundation . Prop. Line ... .............. O [ ] ------------- Length of each line----_----------•-•-• tat Length LEACHING LINE` No. of Lines -- .�—.--- -- .De Depth Filter Moteri I ...-•-•••......--•---•.... •................ 'D' Box Type F+Iter Material •.................. p � Foundation roperty Line ------••----•------••--•P Distance to nearest: Well ............... "- SEEP L 1 Depth Diameter .... Number -------------- ------------• ... ck Filled Yes ❑ NO [7 ' Rack Sire Water Table Depth .. Line ...................... Distance to nearest: Well. .................. .......--•--••--- .. Prop. i . Date ........•-..... .............. •] REPAIR/ADDITION(Prev. Sanitation Permit d# ..................... w .�:. . Septic Tank (Specify Requirements) --•• - .r :_- -•--•-• --- -•............. Disposal Field (Specify Require eats -----..... -------------------•- ------- i .. G . ............•....... . (Draw existing and required addition on reve�se'side] I hereby certify that I have prepared this applicatlon and that the`work will be done' accordance with San Joaquin County Ordinances,..State.Laws,=and-Rules-and Regulations of the San .ioas:uinFLocal Hoc{th District. Hanle owner or {icen- sed agents signature certifies the following: to any persons`In such manner "I certify chat in the performance of the work for which this permit is issued, 1 shall not ern y as to become subject to Workman`s Compensation laws of California." I 3 ..------ Owner i Signed . Title tt ...-- iBy ..................... o er than owner) ! "� - - -�---- F R DEP RTMENT USE ONLY _ ' DATE �. APPLICATION ACCEPTED ' "'s.—DATE. DATE,. .. ` Com` �• BUILDING PERMIT ISSUED ...---••--•--•------------------------------------------- _ . ADDITIONAL COMMENTS _... ...................... ..._..--,.-.....__........._.:..__....,_.._.........._... i _ ....--------•......... ................ __.... .. .........................✓ .. ........ ................. .......................................Date _�,r - /��f .._............ Final inspection b . . // t SAN JOAQUIN LOCAL HEALTH DISTRICT C 3. e,fey�V G= 4 - 7/72 3 M i _. 111 24oe.. KM