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J FOR OFFICE USE: APPLICATION FOP. SANITATION PERMIT Permit No. _..7zl-673 •- (Complete in Triplicate) 1..� ...� Date Issued _ .............. -- „_--.... This Permit Expires 7 Year From Date Issued Fi 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 Regulations: JOB ADDRESS/LOCATI N ..f_-77+x • ._ .. . -,�.el` ._.-•--•----------------------•-•---........CENSUS TRACT ..........._............. : i - .. ... ... gt,. . . ................................ Owner's Name .. ., ----- .__._ �� . _. Phone Address .............................. Cit ... { Contractor's Name _... — - -_.. _ ._. � License #1 "�" . Phone;:....................... Installation will serve: Residence ❑Apartment House❑ Commercial ❑Trailer Court Motel ❑Other __-_._ A C� ----------:<---•-.. 1 Number of living units.......__ Number of bedrooms ............Garbage Grinder ............ Lot Size ....... Water Supply: Public System and name -------------------------------------------------------..........................................•............Private + Character of soil to a depth of 3 feet: Sand Ej 'Silt❑ Clay E] Peat CJ Sandy Loam ❑ Clay Loam ❑ a Hardpan Adobe CQ Fill Materia! ............. If yes,type .................. (Plot plan, showing size of lot, location of system in relation to wells,.buildings, etc. must be,placed on reverse side.) h NEW INSTALLATION; (No septic tank or se'ep6 ge pit permitted ifR ublic sewer is available within 200 feet,j , __ ._- Liquid Depth ....I/_----.--.--__---- PACKAGE TREATMENT [ � SEPTIC TANK� 5iae._�/� ._..1.�_ _._:�.___ � Capacity - -46-a--- 4 Type --- MaterialNo. Compartments ...................... Distance to nea st: Well ........ .................Foundation -----vn........._.. Prop. Line ..._ ...............J i LEACHING LINE {GY/ No. of Lines _____ ______________- Length of each line---- _.__.__..._ � ..__. Total Length ------U•/----- ........... �s 'D' Box .---- --- Type Filter Material ....5.4.:..-Depth Filter Material .__-_-�1�y...---__•..... .............:... Distance to nearest. Well ._...:24?A-------- Foundation ...�............ Property Line ................. I S"` SEEPAGE PIT [ Depth _.._PP_____________ Diameter --- Number ....------#1........__:.... Rock Filled Yes No ❑ �� N LL Water Table Depth...............f�e-----------_---_ --------Rock Size Distance to nearest: Well ---------•_••---.__..Foundation --- .�_._..._. Prop. Line ��---------•-- - ri� REPAIR/ADDITION(Prev. Sanitation Permit°# ---------------••----•-------•--------•--•-- Date ---.-----_..__........_..._...._..} Septic Tank (Specify Requirements) ----------------- -- -.-....-----------------•---------....----•--•-•---------------............--------•---.... Disposal Field (Specify Requirements) ...............................-..---.................................................--•--------_---------_--- ----•---------•--• . ------------------------------------ ----------------------------------- ----------------------------------------------------------------------...------------------- .................................... 09 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 Joaquin local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work far which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." F, Signed - s .... Owner $Y ....---- .-------- --- ------------------------- -=�-s- ---� Title ........................................ (If other than owner) k I FOR DEPARTMENT USE ONLY. ... APPLICATION ACCEPTED BY ...---•-----...: ---- ---••-e-- --------------•----------------•-----_...--•----- •----------------- DATE ._.., .;3b. ..7 ._......__ BUILDING PERMIT ISSUED ......V_ _ .. ......... .... DATE ------- ................................... . ADDITIONAL COMMENTS -- � /x�...... f C ......... - _ ............... ........ = Date ._.T.�-C? _.. 7 _._. .... Final Inspection by. ----•----------- ................ - - SAN JOAQUIN LOCAL HEALTH DISTRICT