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FOR OFFICE USIA: APPLICATION FOR -SANITATION PERMIT" Permit No. 7-7'- ... �YY ............................................... iCar,rtpieteht Triplicate) a Date Issued .. .`.".....::...7 This Permit Expires 1 Year From 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 Regulatlonst JOB ADDRESS/LOCATION ........... --jlea.- vj. ......CENSUS TRACT ....... .............. .....Phone Owner's Name , l ...................................�-----• .................................. Address ...------------ :"T.�.... --•------------------ City _...._...... ..._i/�.C .. ----.... ........... �..c� -- i ----.License # . . L ------- Phone . �3�._. Contractor's Name ----------4 1� ------�-- •w�-r-------------------• - r Installation will s Residence Apartment House 0 Commercial oTrailer Court 0 i f Motel 0 Other------------------__-----------•---- ; Number of living units:_._.:_ ..... Number of bedrooms --_-;L-Garbage ander ............ Lot Size ______________________ __ Water Supply: Public System and name -.--.__.... .s._._._. .. '`` ........... .......................private Character of soil too depth of 3 feet: Sand o Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam 0 Hardpan 0 Adobe 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 available within 200 feet,) PACKAGE TREATMENT I I SEPTIC TANKI Capacity ---------- ----•- Type ................. Material...................... No. Compartments --•------------------- Distance ------- .-•- Distance to nearest- ,Well _____________-----------------------Foundatio f__.-_.-__-..... Prop. Line _ �--f...... p I ... Length of ea I�ne .._... Total Len ..............:...�1 R LEACHING LINT= [ ] No. of Lines - p 'D' Box ! Type Filter Material ......... .........Depth Filter M`ateria�`�� '..-.L�.� ...._../..//.��.. '.:._. Distance t ear st- Well -,goo �aundation ......�....._._. Property Line ....,G.(✓....,••••:••• SEEPAGE PIT [ I Depth .. Di ame r Number ...._-.... •• R ck Filled Yes r No b Water Table Depth ------.Rock Size k Prop. Line -•---- ------------ Well ._...-. --•_ Distance to nearest: :•Foundation ----------=------- REPAIR/ADDITION(Prev. Sanitation Permit# ------ - 6 •• ./`t��.Gt�?1.� Daf$ _...----•-•--•_ •• Septic Tank (Specify Requirements) ............... ....... --------• ......... ...-------- Disposal Field pacify Require ) Q- a i-....-- � ..t_S ...�_v` ................... ... t ---•- 7 ........... ►�, •-- --- ------ ------------ ..................................... (Draw existing and re wired addition on reverse side) 1 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 Joaquin Local Health District. Home owner at licen- sed agents signature certifies the fallowing: "I certify that in the performance of the work for which this permit is Issued, I shall not employ any person In such manner as to bac a subject to Workman's Compensation laws of California." Signed ----- - ---------- .------••......------------.....--•---------. Owner B b.� � ......................... Title _-..--- - ------ �� Y ---------•-- - ------- _ -. (if other than owner) FOR DE ARTMENT SE ONLY f APPLICATION ACCEPTED BY . -- ------------•.----------• .................... DATE i BUILDING PERMIT ISSUED ------ -------------------------------_DATE -.---------- ADDITIONAL COMMENTS ---- - -- ----,..--- = ------ - ----------- -•--.......--- ----- ---------------------............................................... •------------••----------•---------- --------------------- .._-- --.. ....... ------•--------------;---------------------- .-- ....•....__..------........ final Inspection b Date ....-. --- -" --1--- EFl 13 2!1 1-613 rev. SAN JC►AQU#N LOCAL HEALTH DISTRICT 8/71a 3M