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FOR OFFICE USE: aPPILICAT1oN FOR SANITATION PERMIT VS Pa 4... :........_�_._:.:.. �....... .. _ .(Complete In Triplicate), _ ` __.�s rmlt No. .._...............7 - Date Issued .. �!�S This Permit irxpires Z Year.From Date Issued -_ i Application is hereby:made to the San.loaquiri local`HealtEi Disfricr for a-perrnit--to constructand`I stal"Iie work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and kegulaitlons: JOB ADDRESS LOCATIO N___-,_....?. .!/:f?.�1_<`i�._.:_. .. _:':_.. aNSUS TRACT _ ... .�.. Owner's Name -•�r-r� Phone � y7__ Address l _......_.... ---•-- :. .............•-...... .............. ._-:.-•-•-•-....:city 4.......................................... - . Contractor's Name License* Phone ............. ..---•- __-- ; -------•--.._...------ Installation will.serve: Residence Apartment House -Commercial ]TralEer Court ] I Motes [I Other.. Number of fivrng. units.---.y Number of bedrooms ._..:_.Garbage Grindelot Size - x__r`" -�------------ a ..............:. Water Supply: Py System and name .L 'I1 a2•- cr �k.1; :. ..�--,---:_.:.._._ Private ❑ Character of soli�to a depth of 3 feet: Sand . Silt d Clay []�PeaT Q- Sitndy Eti�) day Loarri � . J .Hardpan(] Adobe Q FillfiAateirial ............If yes,type..........,... ........ ... ! (Plat plan; showing size of lot, location of system In relation for wells, buildings, etc. must be placed ani reverse side.) NEW� INSTALLATION: (No septic,tank or seepage ermitted Ifpublic sewer is available:within 200 feet,)'(/ 4 PACKAGE TREATMENT I ] SEPTIC TANK If � Size_...._--____•- LiquidDepth q ! lrf�Eapacst 5 TYIe Material:•:4`max ..:....~ No. Compartments ...................... Distance to nehest Welh,/_ __ _____________Foundation ....-..._.•........__ prop. llne ...................... LEACHING LINE ( 1 No. of Lines _______________ _____ length of each line........................ !_"TotalLength .............. 'D' Box .f_... 'Gyps Filter Material .........:..........Depth .Filter Ma#efia�>>� � ••----.._............ Distance to nearest. Well .. ...--•............. Foundation ------- _--------_-- Property Line ....................... SEEPAGE PIT [ Depth\----------- . Diameter _____________ _ Number ------•__-• + ........h_..... Rock Filled Yes ❑ No 0 P Water Table Depth _...,......... f ...:Rork Size ........... ................. ar. ....... Distance to nearest:Well-=..-____•-_____._.._.'.. ...Foundation -------------------- Prop, line --------•-----------•- REPAIRJADDITION(Prev. Sanitation Permit# ........................... Date 1 Septic Tank (Specify Requirements). _..;.... - - -----......:.. :....!- _.....:. ® , --------------------------.._-••--- ---._........_..-•--•- Diposalield (specify Requirements) ..._l�' GF,._.��.,c`".:_ . ...... Disposal X_f ._.c9:_ t 2- { ._...._ --------------•-•--•.....................................------- ----------------- • ---••-•••--------•--.................. -----••-------•-•••••. -----••--- Prow 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=tli�J n:yJoaquin Local Health:District. Home owner or Ilcen- sed agents signature certifies the following: "I certify that in the performance of the work'for which this permit is issued, 1 shall not employ any person in such manner as to become ect to Workman'sCompensation Laws of California." ,y Si ned 9 --- - �.-•----•----•------------- Owner . BY •-----••---- •-•-•------•-------- •-------------- ---••---- Title ------------ .. — (if other than owner) R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ' ....................._-----------••-••-•-.. -_--._---- .._._..,...DATE"^-.- �-~7 ._...:,,..,..__ BUILDINGPERMIT ISSUED ------------- ------ ---------------------------------- ........-...-.-------- ---•-----•-•- ----------DATE ..........................................:.. ADDITIONAL COMMENT'S ------------ #---------------- ------ - { . '-------- ' ----------------------------- - ---------------------------------- -- •------••-------- ••--------- --• - -------.----•-----•-----------------------•- ---- _ Ina inspection by: _. _. _.. -•- • . ............Date _-. .. .7• ............... .... .......................•--- ---•-• ' EH 13 2! 1-68 Rev. 5 SAN JOAQUIN LOCA! HEALTH DISTRICT 8J711 3M