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FUR OFFICE !USE: u _ APPLICATION _ FOR SANITATION PERMIT �• c, ..........I. .. ....................... _ _ (Complete In Tripllcate) Permit.No. : r8/-,. _ . �:. TMs Pennit Expires 1 Year From Date Issued Date I:sued . "x....77 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 ADD 55/LOC'x.4 ..�./..Z7. . . -.... .. .1� s.....•..... ......................CENSUS TRACT Owner's Name . .r........v.....: /[-• % '1 .. ....... ..... . . 'J�Q............ Phone Address . . ...... S . v G ty. .., Contractor's Nome . ... r? .•_.=-.. ............... .License . .... pho'" --- 6 . 4.Installation will serves ;, p Residence O( � _M Apartment Housefl Commercial QTraller Court ❑ Motel El Other i ..................:.......... . 1.:. Number of living units:.......-- Number of bedrooms .....Garbs a Grinder 4 g nder .......... Lot Size Water Supply.. Public System:and name ........ . _ •.Y.v.__... .:....:...r.:rs s :. . N •= w vete Character of soil to a depth of 3 feet: Sand f t. M. '�]r Sil!Q_ Clays❑ .. ;'eat(]1; Sandy Loom fl Cla loam.� Hardpan E AdobeFill Material ........_.._...:.ff.yes,type............... ........... (Plot plan, showing size of 'lot, location of system in relation to wells, buildings;-etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit,permitted If public sewer is available within 200 feet,) PACKAGE TREATMENT' [ p SEPTlC TANK ] .. ................................:....... Liquid Depth ..................... Cap' dty Type :I i yp ........ Material............... .. No. Compartments Distance to nearest: Well ' ...Foundation . .......................... ..................... . Prop. Line ...................... LEACHING LINE [ ] No. "of tines s ...�_ �_. .....-•...... . ....... Length of each line.---".--- •• •-- .. Tota! Length � D. Box ....-Type -Filter- .............(......Depth�Filter AAsteria! .,.I _�— _� 'z Distance to nearest: Well ..........:.. .......... Foundation-.-.................:_.:...Property-Line ._..:—:.---.--_.._. SEEPAGE PIT [ j Depth ' ........-----. _ Diameter ................ Number ....--. .................... Rock Filled Yes ❑ No 0 Water+Table Depth ................................................Rock Size .......i......... Distance to nearest: Well ........................................Foundation ..._........_........ Prop. Line ............... REPAIR/ADDITION(Prev. Sanitation Permit# - Date ............. .... } Septic Tank (Specify Requirements) ....................-.... V Disposal Field t(SpecifyeRequirernentsl ...................... ....-_...a�'..... .............................................................. ^ ...._..__......-....................a...^._......_..__._......._._.......................... 1 .... .�....` - . s r ._. ............. ......................`....-..::..-._. `'...` 4 zr 1j (Draw existing and required addition on reverse side)'. .... . ` I hereby certify that 1 have prepared this application and that the work will be done In accordance with San Joaquin County Ordinances, State Lows, and Rules and Regulations-Of the San'Joaqula Local Health-District. Nome owner or licee- sed agents signature certifies the following: "I certify that in the performance of the wwk for which this permit Is issued, I shall not employ any person In such manner as to become subject to Worknion's'Compensation laws of California.,, Signed --•--------- ........... By of er th wn rl �•... IO L.DEP MENT E ONLY APPLICATION ACCEPT B _ 4 _ . ......-.- DATE BUILDING PERMIT'ISSUED ....................... .-- ---•.....:.:...... . . .........................................-----......-•--.........."-------- .DATE ................................ ADDITIONAL COMMENTS ......................... r __......... . .. _ .. . ._ . ...............................'- . ------. .......----.....I..................... ; .... ---"----•----•-•--. �, --------- .......................... . .............................................. ....... < -- .••.__..-.-. --- Final Inspection by: -••-- -- -• --- -�.,..f EH 13 2 1-6$ ...............Date ..........---•------..�...........-.- l� Rev. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M