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FOR OFFICE USE. PLICATION FOR SANITATION P j f e t No. . . (Complete in Triplicate) ."- ........... . ...... This Permit Expires I Year From Date slued ed -7.3 Application is hereby made to the San Joaquin Local Health District for a permit to construct and instork herein described. This application is made in compliance with County Ordinance No. 544 and existing Rules d tions: JOB ADDRESS/LOCATION ,a/ .7eL)4?,e14..z........I�AL.GIJ .._.. .. .....CENSUS TRACT . .... ..... .. .. Owner's Name .........llalV.--_-.-._cQ.SF.......................................... :............-----....................Phone .1?,367:7.7 r�... Address . ... I............................. .... -------------------------------------------------- City -0,q_C__ .. . . Contractor's Name .. .-. , 11�L J�...................................................License # -p. .Sitk2... Phone C2,3 Installation will serve: Residence Cff Apartment House C] Commercial ❑Trailer Court ❑ -- Motel ❑Other ......................... .................. Number of.living units:-..../..... Number of bedrooms _-\,3--..Garbage Grinder ........._ Lot Size .,/ � ....................... Water Supply: Public System and name ..............................................................................................................Private ❑ �- Character of sail to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ 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 INSTALLAVON: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ SEPTIC TANK t ) Size................................................. Liquid Depth ......................... Capacity A;a- )_------ Type V0Z1_ 447 Materlai_��7 r^` No. Compartments ... ---f .......... Distance to nearest: Well .. ....................Foundation ..A)............. Prop. line LEACHING LINE [ 1 No. of Lines ..._.�.. ........... Length of each line .... ... Total Length ............................ D' Box .... ..... Type Filter Material -., Xzl4....Depth Filter Material _....11'f................................ Distance to nearest: Well ............. Foundation ld._.............. Property Line .:� _�-----.._...-. SEEPAGE PIT [ 7 Depth .�................ Diameter .v XAL Number ........e�................ Rock Filled Yes jg No ❑ Water Table Depth ......................Rock Size ................ Distance to nearest: Well . ......................................Foundation ..................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ............. ................... Date ..................................I 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 Rules and Regulations of the San Joaquin Local Health District. Ham* owner or licen. sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subleg to Workma ' ompensation laws of California." Signed . ��' . i -... ...__ ----------------- -..........Owner -By ......... ...................... :_..._-7itle ...................:.._................... ....................... S owner) FOR DEPARTME T USEONLAPPLICATIONY _... j DATE ....BUILDING PE .DATEADDITIONAL ...- .......:............_........ ......._... . ............................................•---..............•- .......... Final Inspection by: .....Date .. _-2.z-7 SAN JOAQUIN LOCAL HEALT e 13 24 - 7/723 ,