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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. -_7�_�� . ---- ---------- --------- (Complete in Triplicate) --------------- Date issued 7.._?�-?a This Permit Expires I 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 complionc . with County Ordin ce No. 544 and existing Rules and Regulations: JOB ADDRESSJLOC T10N 1- ` CENSUS TRACT --.-------•--•.------ �.` _ -------Phone -------------- ------•----- -------- Owner's Name ---- - A� �L: � ------ Address�f �.-- - f-',�---.��------�r - - -------- -- ;_ f� f 3[�- •- C tY eR` - #��- L�1 - .:o • _ ,__._.License # hone Contractor's Name' -- r�tC�*�•-C. ---••- - r Installation will serve: 6 Residence❑Apartment •usec❑ Commercial oTrailei Court ❑ Motel❑Other--------------------•----------------------- _ Number of living units:_.___------ Number of bedrooms _Z77'_.-Garbage Grinder _mow--- Lot Size _... ,. .- t'-= ' •---------- Water Supply: Public System and name -------------------------- - -- ---------------------- ----_----..---•--•-------------.----------------Private K_ Character of soil to a depth of 3 feet: Sand O Silt O Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan F1 Adobe C] 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.) NEIN INSTALLATION: (No septic tank or seepage pit permitted if ublic sewer is available within 200 feet,) sr PACKAGE TREATMENT [ SEPTIC TANK Du_le �Size___5 y'C �- Liquid Depth ...- � -S~' Capacity . C'l"---- Type Ma#erial -4 �[ No. Compartments ----2......:.... •�'� Distance to nearest: Well ----- --Foundation .j_ ___-----._. Prop. Line ---------------------- f LEACHING LINE No. of Lines -----�-- - ----- Length of each line -.1'r--- Total Length -•__--,• - �..---...-- D' Box --__ Type Filter Material- __.. .. ......Depth Filter Material ..__- _14 ----------------------- ---. -- Yp t � f ` Distance to nearest: Well -7 ----------- .-- Foundation Property Line ..,ls ._._......,. SEEPAGE PIT [ } Depth -------------------- Diameter ..... Number -----------.---.---------- - Rock Filled Yes ❑ No 0 WaterTable Depth ---------------------------------------- Rock Size -------••----•------------------ Distance to nearest: Well -------------------------------- Foundation ----------------- Prop. Line _--................... REPAIR/ADDITION(Prev. Sanitation Permit# --------------------- ------ •---- Date ..,----------•--------------•-----) Septic Tank (Specify Requirements) ----..--_--------------------- •-------••------------- --- --------------------_-_- 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 Joaquin County Ordinances, State Laws, and Mules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify at in the performa a of the work For-which this permit is issued, I shall not employ any person in such manner as to beco ublect to or n's �npensatio laws of California." Signed'.�-1�-Lt 4� 1�k = 1.. Y ------ -- ------ -- -- --n_.o- nor-•------- �l {If other than owner[ FOR .DEPARTMENT USE ON Y 7T =� ._... APPLICATION ACCEPTED BYy' DATE -. ....... BUILDING PERMIT ISSUED -----------•------- 7�_ :' ------------DATE ----------•-----------•--------- - ADDITIONALCOMMENTS ----------------------------------------------------------- -.... ------------- --.._..--------•-------- -----------.---.__.,_.------------------------- x J ----------------------•--------•-------- ----------------------------------------------------------- -._......._....---------------------------------------------•------------•----------.._...----------- ------------------------------.......------.--------------------------------------------. ----------- - - -------------- - -- ----- ------------------- ------- ----------------- ---------- - Date _;9--g --------------- ... _... . Final Inspection b SAN JOAQUIN LOCAL HEALTH DIST CT i 1, E. H. 9 1-'88 Rev. 5M