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FOR OFFICE USE: r,,..PPLICATION FOR SANITATION PE,.,,,IT - - (Complete In Triplicate) Permit No. .7�-.%7_a-, _..._.. This Permit Expires 1 Year From Date Issued 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 Regulations: JOB ADDRESS/LOCATION 7`7E'� '� _ L im _,.. - CENSUS TRACT .......... .......... -�lL u Owner's Name ✓�o e est i ....... - f ....Phone ... ....... .- ... . . . .� Address City if Eek - Contractor's Name nz1ev License # ./�F 3f ? Phone - .... ........ .... Installation will serve: Residence eApartment House 0 Commercial []Trailer Court Motel ❑ Other -- - Number of living units: �„ Number of bedrooms .__ '_._Garbage Grinder _ Lot Size cscQ..X �� Water Supply: Public System and name __ .__-- .._..--.-. ....__..........- _--__ --.Private Character of soil to a depth of 3 feet: Sand r]! Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe (B 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,) [ ] . p 1 p g pit permitted if public sewer is available within 200 feet,) ... yJ/ / /' / 1 Size; � X � �� : Liquid Depth __. .. .:-- S NEW INSTALLATION: (No septic tank or seepage e PACKAGE TREATMENT SEPTIC TANK Capacity , iType . Mater_i_a_lNo. Compartments Compartm ents z-------------- -� _,- Distance Foundation 1V �Prop. 7 ........ 0 LEACHING LINE [IJ/ No. of Lines 6% Length of'each line g . Total Length ,<7n_ Type - Depth Filter Material ..1'.d'..-._ - 'D' Boz ( � T e Filter Material �:: �: .,-_........... - Distance to nearest: Well C Foundation It-, _i Property Line �j` � L SEEPAGE PIT [iC Depth Diameter 33- Number Z. Rock Filled Yes ff� No C A Water Table Depth. ....f. 0,0_ -------Rock Size _I t �. .X..-- --------- Distance to nearest: Well 1 Sc.. fA _._ Foundation l v Prop. Line ... . J REPAIR/ADDITION(Prev. Sanitation Permit# Date _: ---- .,Septic Tank (Specify Requirements) Disposal Field (Specify Requirements) _- ---- ---- - (Draw existing and required addition on reverse side) 1 hereby certify that 1 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: _ "1 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 subject to Workman's Compensation laws of California." Signed _ Owner n By . ..... _ ..... �y,K t 11 :-._ :Title z (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY T�G.¢ �� f� to _. . --_ _ _ DATE BUILDING PERMIT ISSUED DATE ADDITIONAL COMMENTS it l 5 �' t // _ . _ Final Inspection by: - / _..`-�� .-. Date .. -_.- --� c1 `'f�� SAN JOAQUIN LOCAL HEALTH DISTRICT 11 7G. .,.. .. _.. ..