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► ' FOR OFFICE USE: l APPLICATION FOR SANITATION PERMIT Permit No. ...�.�....�/3- (Complete in Triplicate) This Permit Expires 1 Year From Date Issued. Date Issued . p' 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 gounty Ordinance No.454and existing Rules and Regulations: JOB ADDRESS/LOCATION ......__ __,... X._... --....... .. ._.._.....CENSUS TRACT .................:........ Owner's Name .....,�}�/��". ,Ax..4 �...y�------------- •.----......_---.._ Phone . s ... Address --. 7147,12. .... ....... City --------------•--•--•••--........... Contractor's Name . ....�.....� ....License - '� 1..... Phone , ? r . Installation will serve: Residence NApartment House C❑ Commercial ❑Trailer Court 0 Motel ❑ Other,-...... ..,_....:... -- ................ r Number of living units:........ Number of bedrooms __.a----Garbage >Grinder Lot Size .......... iWater Supply: Public System and name ---4 riL .....`..........;..................................Private ' Character of soil to a depth of 3 feet: Sand E]' Silt 0 Clay E] Peat❑ Sandy loam {�( Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ...... ..... If yes,.type -'.............. . .... (Plot plan, showing size"o.f.Alot, location of system in relation to wells, buildings, etc. must be placed on ,reverse side.) I NEW INSTALLATION: (No septic Tank or seepage pit permitted if public sewer'is available within 200 feet,) PACKAGE TREATMENT SEPTIC TANK.� � 2&_X ze�.�-- -------------------------- ............ . Liquid Dept ........ .................� Capacity _. ...... Type _-.......... ...... Material......... No. Comportments --•---•-----...----__-,wy Distance to nearest: Well . ... ..`.._ ------------------Foundation ..... Prop,Prop, Line --__---_-_-_ N LEACHING LINE [�` No. of Lines � Length of each line . ��.: .............. Total Length _.. j___-._._...__.__. D' Box .._. Type Filter Material ..19► co_ ---.-Depth Filter Material ... ___________y._.. ! Distance to nearest: Well .. " -------------- Foundation . .. a..f.'...-_. Property Line .............. Depth [7 p �® - -•-..�._ Diameter �!-'--�,��-_ Number ..._._..�--------------- Rock .Filled Yes No i� Water Tabie Depth _.._.._•----.......................Rock Size _...._...-_ ........... ?, Distance to nearest: Well ....f��---� ! � y - ------------------------Foundation ....... Prop. Line . REPAIR/ADDITION(Prev. Sanitation Permit# -------- ---- ----------- ------- Date _.---------------:,---------------I Y F Septic Tank (Specify Requirements) Disposal. F4ie eci{y Re uirements) .-- _ _..... } (Draw existing and required addition on reverse side) , I hereby certify that 1 have prepared this application and,that the work will be done in accordance with San Joaquin f County Ordinances, State Laws, and Rules and Regulation's of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: a "I certify that in the performance of the work for which this permit.is issued, I shail net empley any person in such manner as to become subject to Workman's Compensation~iciws of California." Signed Owner By ..._ Title (If other than owner) ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED•BY .... 1 _.. ...... DATE ..... ........... BUILDING PERMIT -ISSUED ................ .. __..DATE -.---.._.._.......-_..._.._...._...,..... ' ...-- -------.._...---------------------- ADDITIONALCOMMENTS ----------- --------- ---------- ...'-.._.._..................---. ....._.-.., .. ..........._.....---.............__ ...... -•- -----.----•---- . .................. -- ... •- i ------- -- -------------------------...-....-----------------------------------.--...... y Final Inspection b _Date ........ 7 SAN JO QUIN LOCAL HEALTHDISTRICTr