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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ` Permit No. 7 J–65.. (Complete in Triplicate) -------- This Permit Expires 1 Year From Date Issued Date Issued .°.F- Z7.... 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 mode in compliance with County Ordinance Na, 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ..--�j� .' _..._....._. �:-4--- .._.f, ll�`'...........:........CENSUS TRACT .....----...-----......... /Z I Owner's Name.- .L,G-LII// 'z-.f, .............................................................. ............Phone . Address -a3 ... �_.., ................ Contractor's Name __.f I'� .----�,�• ,�]'�... IVI<.. 62?..License # t;,• 7'9'9.7 Phone .AjA.�r.�j�:..�� installation will serve: Residence%Apartment House Commercial❑Traller Court ] , Motelp Other............................................ Number of living units:.... Number of bedrooms -.,,...Garbage Grinder Lot Size � x. :57 /.............. .............. Water Supply: public S s and name ............. Private ❑ Character of soil to a depth of 3 feet: Sand Silt 0 Clay ❑ Peat❑ Sandy Loam 0 Clay Loam ❑ -- ----r— Hardpan j] Adobe Fill Material - lf.yes,type..:............. ........ ... (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. m st,be placed on reverse slide. NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200.feet,) PACKAGE TREATMENT [ ] SEPTIC TANK f ) Size........................... liquid Depth ..'...--.---..:---...... .................. . . Capacity i , .. = Type.------------- •--- Material.--------- "----...._ No. Compartments Distance to nearest: Well ------------- -------------------:_foundation ---------------------- Prop. Lin .................... LEACHING LINE [ ] No. of Lines ------------------------ Length of each line............................. Total length .:_ ?- 'D' Box ............ Type Filter Material ....................Depth Filter Material .. Distance to nearest: Well .............I.......... Foundation .........:-------------- Property Line ....................... SEEPAGE PIT Depth .................... Diameter ................ Number ........__.... ............. Rock Filled Yes ❑ No Water Table Depth .......•--••--•.........................Rock Size ........................... l + Distance to nearest: Well .............................. .........Foundation .................... Prop. Line ---..............-. - REPAIR/ADDITION(Prev. Sanitation Permit# ...'...................... ... . :.. .. ..... Date ......... -: �. Septic Tank (Specify Requirements) .......... .....................:,-.............................. ._.._..... Disposal Field (Specify Requirements)•:.........._ _----..,� / ----� , �/ -------- !_Il ...... ....... 3 6s` : -----------------------------•--------------------• --------------------------------------------- ----...................... -- •-------.................._.. s (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 San Joaquin Local Health:District. Home owner or licen- sed agents 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 Workman's Compensation laws of California." Signed I ________ Owner BY .:._---------------- --------- •. -- -• -----` Title -._.. (If other the ner) ----..-....... _-- FOR DEPARTMENT UISE ONLY " APPLICATION ACCEPTED BY _.._ - DATEP-:l.I,-7Z- ---- ------ BUILDING PERMIT ISSUED----------------------•-•--........................... ----... ...... ------ ADDITIONAL COMMENTS ---------------------•-•.....------------....- e . . . • . . ....... .... •------ Final Inspection by: ------.----•--------•.......................--------....---••-------- --._...----..._.._......... ................... ..___-- � AQUIN • ....................Date .. .: T --................. EH 13 2t, 1-6$ LOCAL HEALTH DISTRICT 8/7h 3M '