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FJCE USE: FOR ©!" APPLICATION FOR SANITATION PERMIT 7.......................... .............. (Complete In Triplicate) Permit No. 7...�.....Z ............... bate Issued �° °- ....._ :................................ This Permit Expires 1 Year From Dat*Issued ......... .•7 .... . 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: - t JOB ADDRESS/LOCATION �/—?9_ .-._. 1 _/. 04......� A.&VV.CENSUS TRACT ..:....................... Owner's Name WV .. .................:....... Phoneme . .r ..:Address -. �� -. ii .._ city ' - " Contractor's Name -- ,4 .R,¢+essL.., s/kcr....License#e �''f�. __ Phone .. I Installation!will serve: Residence P(Apartment House] Commercial OTrailer Court 0 Motel ❑Other_ . Number of`living units•_--_J� Number of bedrooms ---3....Garbage Grinder -- Lot Size ... !�- •-•--& Water Supply: Public System and Warne -----=----------- ........................................_-..........-......................._.•........__.....Private Character of soil to a depth of 3 feet. Sand n Silt 0 Clay 0 Peat❑ Sandy Loam 0 Clay Loam 0 Hardpan Adobe E] Fill 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 availgblewithin 200 feet,[ PACKAGE TIRE .I. ATMENT SEPTIC TAMC Liquid Depth ---_-- w Capacity Type hiV49ZQVMateriZ�4W/A9W_ o. Compartments Distance.to nearest: Well ... ..._.... Foundation l .... Prop. Line . LINE ( ] No: of Lines ------- .._........ Length of each line.. Total Length - .� �. / 19' LEACHING ......... ........•-�� - -- � ..._.. V Box .._/--. Type Filter Material .��,QlG'r a Depth .Filter Material ....... ....-.- _�. ... 0 Distance to nearest: Well ---// ._.... Foundation ---_ ........ Property Llne _. . - pth ._. �____ Diameter __. �e Number - R Filled Yes No 0 f T De ---•--- �. Water Table Depth _.� SEEPAGE Pi P ------------•---•_.....--•---•------•---._......Rock Size ------- ' Distance to nearest: Well ..___. ..Foundation .../A� Prop. Line -_-_-------- REPAIR ADDITION(Prev. Sanitation Permit _ Date } Septic 'nk 1Speci.fy Requirementsy ...:............................... cs Disposal -------------- �1 Field {Specify Requirements) --------•- _----------•--•-- ------------------- ----•--•---•----------------- --------------.-.-.............. ._... -------------- ------------- --.. . --- --:..-------------------------------------- ----- --------------••--: ----- ------••--•..................................................... •_....................... �+ (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work milli 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 far 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 -- --• --- =-----------•- •---'Jned ---- ------------- -------------------------------------- Owner 01 BY Side . ----------------_------------ ---------- (If ----------- •- (If other than , FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - .................. DATES'A._P!.P.�?7--------------- BUILDING PERMIT ISSUED -" ----------- •-•-• • -----------------------DATE ....... .......... ----- ADbITIONALCOMMENTS --------------------------------------------- .............I............ -........... ......... ----------------..----........................... --------------- ------------------------------ ----------------------------------------•-------------------..--.--------------------------- .............................................. ..................;.-------- -----------.........------------------------•- ............................_._.------.-.-..------------------ .................._.....---------- ` Final Ins eetion b ` Date 1 -..µ.. P Y •--..._.................................--•--..--...------.-•--• EH 13 2� 1-68 IIA-v• 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7b jM 1 . I