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FOR OFFICIE USE....- APPLICATION FOR SANITATION PERMIT If/J ..................................._........_........... Permit No. -_7e.: - - m )Complete in Triplicate) .....�.�:,.z. ..............•-•---••,................ This Permit Expires t Year*rove Date IssuedDato 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 T ............................................CENSUS TRAM Owner's Name phone • ------ •-•• Address ------ -------- - ..City ................. ----------- Contractor's Name ../ -s-:--, -- `. License# r�. �� Phone 6 -�60� Installation will serve: Residence(Apartment House Commercial❑'€railer Court C) ' I Motel ❑Other ............................ -�-•�•p----Lot Si ! 7 Number of living units:....-- -•-- Number of bedrooms ....•----..-Garbo a Grind .............._----- ------------ Water Supply: Public System and name ..................................-_.----__ _.....� ..:.. A-�sa ........ ...... .........Private❑. Character of sail to a depth of 3 feet. Sand ❑ Silt❑ Clay ❑ Peat Sandy Laam ❑ Clay Loam I Hardpan 0 Adobe&CF111 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: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT SEPTIC TANK j ....... Liquid Depth r [ ] Size---------------------------------------•• •-------•--...........---•r Capacity - __ No. Compartments 6 ---------------.._:.,_TYPe°�----------.-.---=--Nlc�teriai-=--�--------------- .................... Distante to nearest: Well : Pro Line W __Foundation LEACHING LINE [ j No. of Lines ...._------ _------c.(Length of-each line.....:...................... Total Length --_-------____ - 'D' Box ............ Type filter�Material :`..................Depth .Filter Material .--••--................_. ...... ,// ____•----- Distance to nearest: Well ________________________ Foundation ----------------_.__._.. Property Line ._..-_..---•-•----•-__-•p. SEEPAGE PIT ( j Depth _ ❑' '* ❑ P -------•-=-.:.._._.. Diameter ............... Rock Filled Yes Number ------------._.,_.. _. �. Water Table Depth ---......____....................i.........Rock Size ....--------------•---------•-•- 4 ------Distance to nearest: Well ----------- .»_Foundation ...... Prop. Line ................. vzlj REPAIR/ADDITION(Prev. Sanitation Permit=rr1•` ..............'"`.......................... Date ------:........................... ) , Septic Tank (Specify Requirements) --------------...........................-.......................................---------................ � Disposal Field (Specify Re irements) -- _---- --------------------- _ ---- __ ---_- ..... 7 *-------„------ -----•--- • :. ._ .__ k._... !� O` __._.....�-.-.,? .-�-- �.... .. ---------------------------- (J (Draw existing and required,addition on reverse side) I hereby certify that I have prepared this application and thdt the work will be stone In accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of'the San Joaquin Local Health.Dislrict. Horne owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this peirmit Is Issued, i shall not employ any person in such manner as to become subs orkman's Coma sation laws f California.” Signed17-c-------- - ..---- Owner BY ----- --------- ------------------------------------ ------- - T�tl _ ..------.._._._..-..... {If other than owner) R [9EPARTMIrNT USE ONLY APPLiGATION. ACCEPTED�f3'Y':- - DATE BUILDING PERMI - .. .............: T lSSt1E _______ ---- ....................., •._---- ------__._DATE ................................... = ADDITIONAL OMMENTS ---------------------------------------------- . =E .._..._-.-. - ---------- ...' r _____________..-___._... ____..-_.Y,W-�_ __ f X __....... ___.--____-.-__ .____.. -__..__-.-._-_._---.-___,,..-.._____---___.__._. - _...____..__ _...____.____...-_..__..- .... -- final Inspection lay: ._------ . _.........._ .. - - -- .......•........... ............................... _ ...Date -- ...... '°.13"2h ]-6$ itev. AN JOAQUIN LOCAL HEALTH DISTRICT � X41 .wS45•,-