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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. .-7 " G.�.y. (irompiete in Triplicate) Date Issued ..-7 �•• .. This Permit Expires 1 Year From Date Issued Applicotion 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, r .................................. ...............CE JOB ADDRESS/LOCA / 4 TION.. ._. �J �.......................... ....................Phone Owner's Nome �e-1..q pk ...1 .a. l" 9aol._...L° .................................... . ---.............C Address ............... ...7� °t �,s .. _,gip- ity -33 Phone Lcense .. .... _,. Contractor's Name ............ .�._ _i4 r .t�...T...' ! ................... installation wit! serve ' r -Residence House-Q`Commercial fjTroiier Court--❑--•"— - * j Motel ❑Other ................ . .. � �p0J o� r Garbage Inde. lot Size ..--.-- j.__._ Number of bedrooms r '= ` ' , Number of living units:..:. .Private�• ....: ...............:...................................... Public System and name ...._.......•--••....................... __...r...�----_, Water Supply: Silt Clay Peat 0 Sandy Loam ❑ Cloy Loamks [] Character of soil to a depth of 3 feet: Sand 0 ❑ ❑ j______.r__ a........................` --- Hardpan Adobe 0 Fill Material ....�---•.--if es,typ Piot Ian, showing size of lot, location of system in relation to wells, bvitdingC etca must be placed on reverse side.) ( p ' � y NEW INSTALLATION: (No septic tank or seepage pit permitfe8 if public 4evver is available within 200 feet,) S - ....... SEPTIC TANK� j Size._.>.'��?_ ..... ........•----... Liquid D PACKAGE TREATMENT ( ] S ?i: _. -- -!� 4 No. Compartments ... ..••••••' Capacity �'` -'Material... p tY l!Za.a...... Type . ..... r ..Foundation ... Prop. Cine ....fir----- s' Distance to nearest• Well --•--•-••••••" p Length ch line....- "ACHING ....._. Total length og :----•_---.-.-� 'ACHING LINE ( j No, of lines '�::...�....''N • c. � © �............................. . l +?• ..Depth Filter Mater ials►? 'D' Box Type Filter Material'... v: . -y rt r - r .I� line .. ........... ' �.: •---....�. ... ... Pro Distance to nearest: Well ...... •-•-->•••• Foundation Rock Filled Yes ❑ No Q� -+ i Number ------•--•------ Diameter ,De th .............•-- SEEPAGE PIT ( ) p 11 ... Water Table Depth ............----------------.....................Rock Size _... Prop. Line .._...._ .--....� Well .. .....Foundation --_•-......--•_•-•- .. Distance to nearest: .-••-•-------.._. ..... ..... ) Preva Sanitation Permit# -_-_••-••--•-_._.-»•-. i.....!_... Date ................................. REPAIRJADDITION( _ �................ Septic Tank (Specify Requirements) .................--................................................................�. ---�....._...... ------..._....................._ Disposal Field (Specify Requirements) --- -----------------.... -•F.... ...................... .......................... ._......_..q....;.. . t........._.•............ .... ............. 1...................g with on Joaquin ............................. ........................., _ Draw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and !h at the work will be done in accordance h S d Rules and Regulations of the San Joaquin Local Health District. Home County Ordinances, State Laws, an owner or ren- sed agents signature certifies the following: erson In such manner ormance of the work far which this permit is issued, I shall not em "1 certify that in the perfploy any p as to become subject to Wor an's Compensation laws of California." , Signed ........ ....... ....-•-•--_.--- Owner �j,, ,- M _ By ................ e • ............... ........... Title . �� ""��' :...:.............................. ( other than owner) FOR DEPARTMENT USE ONLY DATE .......`�. - -- -13-..-.---•--- APPLICATION ACCEPTED BY .._... ............. DATE ..........--•--........_......_............................... BUILDING PERMIT ISSUED ... .... ..................•----....... ................... ADDITIONALCOMMENTS...............•, ..................................._....._...._. ......__........................._........_..._....................................... :............................................. :....................... . ..... ............. .... Date............ � .............._. Final Inspection by: .............. .�C `..._............................._ _.. SAN.JOAQUIN LOCAL HEALTH DISTRICT .. y 7172 39 14 74 .