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F OVICE USE: `. a APPLICATION FOR SANITATION PERMIT --• �• ............... ..-...----... ---------- Permit No. ...�3-�- 7f� (Complete in Triplicate) --------------------------- -------------I..... /3 73 Date Issued ...t . ------------- Application ----_ _-.-. ...........---------•--•------------------ ------------ This Permit Expires 1 Year From 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 Ordinary e Ido 549 nd existing Rules and Regulations: I,I JOB ADDRESS/LOCATION --- .- ----- �r.�-..-�.. --...-.CENSUS TRACT ,-- - -7-.------.__. Owner's Name .- ,..."alfge-. -------------------------------------- Phone ------------ ----------------------- Address --....-•--67�1-.��.�-�------------------�,•--------...._...------------------•--. City .�... .L�.�1.��'-----•----------��---------.....----•-------- Contractor's Name ------�Jela r' ----------- ••------ -------License #lel./ ✓�.. :: P o ......... .._.._---------- lnstallatian will serve: Residence []Apartment House Commercial []Trat7fL , Motel ❑Other .................... —''� Number o't living units:... ` � g !.___.. Number of bedrooms ---_.___Garbage Grinder -*,r--- Lot Size ,��--_____________ Water Supply: Public System and name ------------------------ __.._......._..._._....__;-----------------------Private, ` Charac#e�of soil to a depto f 3 eeei:Sond n Silt❑ Clay 0 Peat E] Sandy Loam [] Clay loam HardpanX 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 INSTALLATION_ (No septic tank or seepage pit permitied if public sewer is avdilable within 200 feet,) PACKAGE TREATMENT SEPTI STAN Size._ ) 1 /�/ ��-e�--:•-_-• ............ Liquid Depth _��_._ ---•------------ � Capacit �� ---- _ Type _ Materia!-die-4 --4- No. Compartments _;?---•-______--.-_ 9 Distance Barest: Well _._._ . s - --------------Foundation __ .... ..... Prop. Line ___...._..___.__._._._ LEACHING LINE No. of Lines .Z.............--_-_ Length of each line. / - . ._ f - Total Length X?'2�7�-------------- 0 D' Box ,/�✓ - Type Filter Material /tCaflDe th Filter Material _____________ p _ / 11 Distance to nearest: Wel] -_....____-. Foundation _________ Property Line _ -._._...._...._.... SEEPAGE PIT [ Depth _ -------- Diameter _ ---- Number _-.-- ----------------- Rack Filled Yesk' No IG Water Table Depth ------ ` ------------- --------------Rock Size -/--' - --------_-..._ Distance to nearest: Well .. , --------------___ Foundation .-_ <_l `1. Prop. Line �--_--_-. REPAIR/ADDITION(Prev. Sanitation Permit# -----------------_----------------- ------ Date ----------------------------------) SepticTank (Specify Requirements) -----•------------------------------------------------------------------------------------------------------.--•----•-----------•------------ DisposaiField (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. Rome owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for 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." Signed....... - -. •------------------- ---- - Owner /f BY - .......................... (If othe ion owner) FOR DriPART ENT USE ONLY APPLICA7If�N ACCEPTED BY _... ��- __.._ DATE .�.-...Y...-- ----.....__.._-_-----. ...-.-. -........ ---•---•--- BUILDING PERMIT ISSUED ................ ------------___---------DATE ..........-- ---------r_--------------.. ADDITIONAL COMMENTS ... ----------- ......... ...... --------------- Final Inspection by; ....... ... r hr gr. : .._........... ....................... .......v.... . .�....�........ ---.-._... SAN .JOA,;UIV LOCAL_ HEALTH DISTRICT