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APPLICATION FOR SANITATION PERMIT ................................................... (Complete In Tdpllcate) Permit No. .. 7... .63 This Permit Expires II Year Front Date Issued Date Issued ..E.J;77 Application is hereby made to the San Joaquin local Health District for a permit to construe# and Install the work herein described. This application Isf /made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ./.(r...�.�.�..Y 1��..............................CENSUS TRACT .�._��:.. .7 � Owner's Name ..phone ; j. ... Address ...l .f �✓.. V' -.............. ........�Cdty. _ ....................._..._.......................... Contractor's Name .._-� �..."�!° . ........ ..............License �zPhone Installation will serves Residence MApartment House 0 Commercial❑Trailer Court ❑ i Motel❑Other................................•-•---...... Number of living units:............ Number of bedrooms -_.:....Garbage Grinder ............ lot Size .•.......................................... Water Supply: Public System and name ..............................._..--------........-........_.---................................ , ❑ .... ....Pr€►rats Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loom ❑ day Loam ❑ Hardpan ❑ Adobe❑ F€ll Material ............if yes,type ............... ............ (Plot pian, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on reverse side.1� NEW INSTALLATION: 1No septic-lank or seepage pit permitted If public sewer is available within 200 feet,) PACKAGE TREATMENT ( j SEPTIC TANK'`"EYpe Size..... ....................•............•_...... Liquid Depth .......�..�.•---........\"I Capacity� an •. - .� � Material.................° 1 Na. Compartments _.. .-•---••- Q Distance to nearest. Well ...Foundation -.1G r ...... Prop. Line _(! ................. LEACHING LINE No. of Lines .� E j -------•...:......:..... Length of each line---------...•-................ Tata! Length ...........................� 'D' Box -- --•----- Type Filter Material ----.. .... .....Depth Filter Material '. . ................................ Distance to nearest: Well ........................ Foundation ......................., Property Line ...................... SEEPAGE PIT ( I Depth -----------------•-- Diameter ..........._.... Number .............._. ........... Rock Filled Yes ❑ No Water Table Depth ------- -----•-•................................Rock Size ................................ �1 Distance to nearests Well ........................................Foundation .................... Prop. Line .......,.............. REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ..................................I Septic Tank (Specify Requirements) ........................................................................ --.. ....... ........_...I........._................ Disposal Field (Specify Requirements) .....,�, .......................................... ................•.........................................................................................................-•----.............-...._..-- ...................................... � ..................................................................................................... (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 Satz Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or lice"- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit Is issued, I shat# not employ any person In such manner I as to become sublec to Workman's o ensatlon laws of California." Signed --Z ....I ....i..... . .. Owner By ....................................................................... --_. yitle i (if other than owner( FOR DEPARTMENT USE ONLY f APPLICATION ACCEPTED 8Y ........... ............•--- F'r DATE ......... . . .. BUILDING PERMIT ISSUED ................... ADDITIONAL COMMENTS ..... .......... .........� ,p. ......' .............................--------.............I............ ......................................................... ....... ............................. ................................. ... ... . ....I...... ....LMEZ� .............. Final Inspection by: . = Date' ''.7............... i3 2!t 1-6£3 Rev. 5 [ SAN JOAQU#N LOCAL HEALTH DISTRICT 5/7h 3M