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FOR OFFICE USE, APPLICATION FOR SANITATION PERMIT _........................:...._................_ 7' -Zf -------- Permit No. ._ ., (Complete in Triplicatel ........ Date Issued .1:/�: 7� .......................:. This Permit Expires t Year From Dot*Issued ----.. 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. 544 and exl ting Rules and Regulations: JOB ADDRESS/LOCATION ......./3-C.5 .M.........T 'e�'�^ f�E .,..... 'ENSUE TRACT Owner's Name _..Xta: AAD-----V-..... ...... .......Phone Address ---.......SA.A_j:................. ............ City ...................................................................I........ Contractor's Name XX ........ . ..................License . Phone ...... Installation will serve: Residence❑Apartment House C] Commercial ❑Trailer Court ❑ Motel [fther...1 ,od1ZeAA4VEC........ Number of living units_____________ Number of bedrooms _. ...Garbage Grinder _... ....... Lot Size .100:W?U.......................... Water Supply: Public System and name AY44- .......................Private ❑ 5 Character of soil to a depth of 3 feet.' ; Sand 0 Slit❑ Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ N, . . ._ . hardpan❑ Adobe fl Fill Material ............If yes,type ............... ............ U (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) U4 NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 240 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK jb?00' Size.__ _.._ Liquid Depth ........................... _ Capacity/._2--.6,_!....._-_ Type ----- .............. Material...................... No. Compartments :y............. ` z- f ...Foundation .__�S /. ` Distance to nearest. Well �a ........._ Prop. Line ..5! :. ... .......... LEACHING LINE [ ] No. of Lines ...... ....._. _. _..--- Length of each line............................ Total Length ............................ Type --.Depth .Filter Material ...................... 'D' Box ..----__-... T e Filter Material -----••----•---._ ...................... Distance to nearest: Well ..................... Foundation ....... Property Line SEEPAGE PIT [ ] Depth Diameter ..........:..... Number ............................ Rock Filled Yes ❑ No Water Table Depth ...... •.................... .................Rock Size ------------------------•------- Distance to nearest: Well ........................................Foundation ._........ ......... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation. Permit{# ------ .....-' _____________ Date -----------------------1--•--------} Septic Tank (Specify Requirements} - ' Disposal Field (Specify'Requirements) ........................................................._..-.,......................,.................. •... ..... c F ............. _� . ------------------------------------------ - ....... -----------...................................................... ......................•............. (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 Joaqulrt Local Health_District. Hoare owner or licew 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 becomeW kman's C pen , laws of California." Signed ---- --- . ... . -_.. - .............. _---------- Owner BY -•------------- --------------------- --------------------------------------------------- Title (If other than owner) ' FOR DEPARTMENT USE ONLY c� APPLICATION ACCEPTED BY ------C.'._- .'--- �- --•......... .......... DATE .-1- :-t�-.�.. --- - BUILDING PERMIT ISSUED --------------------- - • .... .._----- ---------------------- DATE ......------------.. ......... -- ADDITIONALCOMMENTS ------------------- ---------------------------------•--.....-----•---.._....__._. ---------•-•------- ...................................................... - ------------------------------•--..........-I——------------ .......... ---------------------1-1 ---------- --..._.._ ........... - ---------------------------------------------•--•----- .._...------------ // Final Inspection by. --------- .' . . _._Date . ...�::.......................... EH 13 .24 1.68 Rev. 5m SAN JOAQUIN. LOCAL HEALTH DISTRICT 874 3M