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FOR OFFICE USE: - x APPLICATIA' FOR SANITATION PERMIT ...... ,:a B 4 (Completein Triplicate) Permit No. 7�4d-;� ._.....-------•....................:... 'This Permit Expires 1 Year From 1)afe Issued Date Issued .3_..:7ZY 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 existing Rules and Regulations: JOB ADDRESS/LOCATION .:....__.. "_rl-•/ ...._...... ».- � '- _ CENSUS TRACT Owner's Name-. .... .e:. . l .. ._.. �. ._.. !�................................................ ..Phone ... . .::.. Address :............... .............................. City -•-- �� Contractor's Name ._:.. ., _�.... .------ Ph ••.................. ............. ..-----•-••••--•,-.....-----• ••--••--.License # s � ._ one•.ca23.e.ale V'e Installation will serve: Residence EO Apartment House❑ Commercial ❑Trailer Court JD Motel ❑Other .............. ........................ Number of living - ,+ A f 'units:.__..___... Number of bedrooms .....Garbage Grinder -_-.--__-___. Lot Size `- .:. l Water Supply: Public System and nlime ----=------- --- -----• •- ... --------... -- iv ....Private `. Character of soil to a depth of 3 feet' Sand Silt Clay_ ❑ y ❑' Peat❑ "Sandy Loam,❑ -Gay Loam❑ Hardpan (] Adobe ❑ Fill Material .:------:._- If yes, type ------------------------ ---- � r (Plot plan, showing size of lot, location of. system.i elation to wells, buildings, etc. must be placed on reverse side«) NEW INSTALLATION: (No septic.tank or;seeps pit permitted if public sewer is available within 200 feet,) f PACKAGE TREATMENT ; { [ ] 5EPTIC'TANIC Sia `e- ` � -•-• Liquid Depth ...... ' Capacity TYPelec-CA'«� ........... ..... Material...................... .-.No. Compartments � Distance to nearest: Well ....6_0_ ....................Foundation . �2..�- Prop. line ..................... •J LEACHING LINE No, of Lines i ` --••- �------_---: Length of'each line.... Total Length D' Box .. N,Type Filter Material ?....--------De th Filter Material Depth .. •---------------- I Distance to nearest: Well ..' j.�,`�.-•-•__ .- Foundation ./C?_-�..--.------ Property Line . ............. SEEPAGE PIT Depth �� X �.--__--.. Diameter y.•.-•---_---. 6�lumber Rock Fil d Yes .--' 4—Water—Table-Depth.......'Z f ?_..Rock..Si�� ..tr -. -- --• - l Distance to nearest: Well ..._./.ra?l----- -_-...Foundation ............. Prop. Line -S-i. REPAIR/ADDITION(Prev. Sanitation'Permit# ............................................ Date Septic Tank (Specify Requirements) .:............ :, . , Disposal Field {Specify Requirements} 1 _ - ------•---•-• .......----------------------•....•• ---...---------••---•-----._.....--•- .. "r------------ (Draw existing and required addition onnreverse side) t , I hereby certify that I have prepared this applicatlo and-that-the-wdrk w4 ill be done in accordance with Son ,Joaquin County:Ordinances, State Laws, and Rules and Regulations of the San.Joa.quin Local Health District. Home owner.or [icon. sed agents signature certifies the following: 411 -- -- - - i l 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 become subi t.to Workman's Compensation laws of Califorriia:" `Signed ._.._tk, _:. e . . I................................... . Owner . By .._.......-t............... ... -----------------------------•----------..... 3itle ._....__..._. ...... : ... �. I (if other than owner) . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ........_r ......_ xL 2 BUILDING PERMIT ISSUED .._..... ._ .................. DATE _.... . -•----•--......_.-- ..... •----DATE . ADDITIONAL COMMENTS ................... ..••. ...... ....- ---••---.._ ............................ �ti ..-..------- ••-•- --...... . --- - .._..---•••---........... ••--••--- ... ...._I..,...... . -•-•...... .._.....----•- ........ Final Inspection b : _ --------------•---------•-----•... •... -----•---------------•-- ..........Date .._ ."`- :.. SAN JOAQUIN LOCAL' HEALTH DISTRICT E. H.13 24 W68 Rev. 5M 7171 1 u