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.7............. APPLICATION FOR SANITATION PERMIT ........................................... )Complete fn Triplicate) Permit No. .7.5 ....... ............ ...............•............................ This Permit Expires 1 Year From bah Issued ' Date 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. 549 and existing Rules and Regulationst J08 ADDRESS/LOCATION ..... /QJ'Q..., � l.�- -!a11 .�T�C—../ f CENSUS TRACT�/ Owner's Na►tredll�.. ........ ........ ......... .. . j.�••:- . �; .• Phone : .c'raress ........1. 7_.�� ... .�.. !1WA4 AV............City .ZZYWIV :....................................I..................... Contractor's Name ........................ .................................License # ........................ Phone Installation will serves Residence Apartment House❑ Commercial❑Troller Court ❑ Motelp Other............................................ Number of living units:......I... Number of bedrooms ...Garbage Grinder ............ Lot Size ................................ Water Supply: Public System and name ......................................................... .. Character of soil to a depth of 3 feet: Sand❑ Silt❑' Clay ❑ Peat❑ Sandy Loam C]. .day loam ❑ Hardpan)( ardpan Adobe Q Fill Material ............if yes,type............... ............ rPlot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTAlWTIONs (No septic tank or see go pit permittee! If public sewer is ilable within 200 feet,) _ PACKAGE TREATMENT ( ] SEPTIC/T�ANNK f Size..... ! .... �:... . ...55:. Liquid Depth .......................... Capacity .�Pi��/ ype!, —, C Material..4AJlli!n...... No. Compartments ...:.--2v............ Distance to nearest: Well .Foundation :LEACHING LINE ( � No. of Lines .......e........... Len...................•--.... ...:... ......... '........... Prop. Line .�O �•. Length of each Ilne. Tota) Length 'D' Box ...../..... Type Filter Materlal� } T� .Depth Filter Material .....�yr�E%rr ..............� Distance to nearest Well ........................ F-fda Ton ...�J :...._... Property Line ....................... SEEPAGE PIT ( ) Depth ...� ......... Diameter ................ Number ...._........�1�......... Rock Fills -�------.�. ft3Pd. Yes X No ❑ 40 Water Table Depth ...............aQ:�7.....................Rock Sin ....r e ....° ... Distance to nearest, Well ........................................Foundation ..10�...... Prop. Line ..................... REPAIR/ADDITION(Prov. Sanitation Permit# ............................................ Date ..................................I Septic Tank (Specify Requirements) ......................................... ....................................................... .... o 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 San Joaqu County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Hoene 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 Its such mannx as to become subject to Workman's Compensation laws of California." ' .a. nod X......... , r ............................................... Owner By ..... ............................. ..................................—..................... ntle ........................................................................ (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ...... ... .............. DAT): ip .. ...Ti.S�"....: BUILDING PERMIT ISSUED .,,...... .... ADDITIONAL COMMENTS . /y,1r•, ' - r�� ltl� .,..... ............. ................ . . ........ ..... ............-...... ................................................ ....I.................... . ..T . --•--..............----................- ........... ..... ............................•---------................................... . ---...._. ..........................................................................—. .... ............. `,�...Ea Final Inspection by: ..----�...- �-...--- ............Date .......... .. 2� � �• SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3N