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OFFICE USE: - APPLICATION FOR SANITATION PERrr-'-,T . t (Complete in Triplicate) Permit No. ..��._�--.-_�--1, ----------- .......... This Permit Expires 7 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 complian e with County Ordinance No,., 549 and existing Rules and Regulations: I Y _ JOB ADDRESS/LOCATION /7e'J._ ?�C. G��,��. ` �j � .� - l�C :��..CENSUS TRACT `. ` /� . F Owner's Name �_.4 ---- -. l Address - .'-{,g' 11 r ------Phone . �� •-' �- �`-.----. -_a .-----`--�-i City ------ . ^� - ----------- - - Contractor's Name ----- �r�-� 1" -� .��. :... �` E= tcense #�-:V, Phone r . .- j7 Motel ❑Other - J T r Court `0 Installation will serve: Residence %Apartment House❑ Co i Number of living units:.....j_-_... Number of bedrooms .._�---Garbage Grinder _---.._.._-- of Size ---- Water Supply: Public System and name ---------------------------------------------- ----- ----- - ------------- --- - Private Character of soil to a depth of 3 feet: Sand❑ Clay ❑ Peat❑ Sandy Loam •❑ Clay Loam. Hardpan Adobe ❑ Fill Material . If yes, type ................------------ f � W (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) 4 NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) V PACKAGE TREATMENT / O f 7 SEPTIC TANK L Size---- ,----x1r-___ - '-_ Liquid Depth .... ------------------ Capacity Z Type .1�_�..__----- . .. . Na. Compartments "stance to nearest. Wel! .fQ�-_--------------------- Foundation ---- Prop. Line ------- _--�0 - -_ LEACHING LINE No. of Lines ------_-I -_ ------ .. Length of - - each line...___!ir �r�----�.f7. Total Length 'D' Box ........... Type Type Filter Material �, ..r- c epth Filter Materia! ._ - .----------------- / r Distance to nearest: Well _AW-------------- Foundation .._�('.-.__....-___- Property Line r ---- ............... SEEPAGE PIT .]/ Depth JV_.---.._ {` P -- .-_ DiameterJ.�.-1V Number ...._.------/------------- Rock Filled Yes No i❑ Water Table Depth ------- --- /! -•-- --------------Rock Size ---f0----. - ---------- Distance to nearest: Well --- -- -------_------------------- Foundation _1 ........... Prop. Line ...3.............. REPAIR/ADDITION(Prev. Sanitation Permit# ...--_....___...._------_- ---------- Date .-. ._..... Septic Tank (Specify Requirements) ------------------------------------------------------ Dis osal Field .(S ecif Requirements) �/��-- IDVr.Sir.II-.... f}-r-----_ -(1',_� P P ; Y q rt 7��PI��/�! - -- .-- �, - �- ,.A {�'kn()7tr(G cI C -.� Q :f � : �7 r>7.'_.. �A.. �- L YSY`R c� �-----o9.1`_---.C�wa✓---A S t. !'t3 u �.tc N -------------------------------------------------- ------- 714-0, - (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 Laws, and Rules and Regulations of the San Joaquin Local Health District. Home 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 shilll not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ... _. -- Owner By --- --• Title . - �_ (If other than owner) ------------ ---- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ..__7r(- _ ,.-----_ 7 c ---------------- -----------------------------------------. DATE ..._.!-_. =f-.. BUILDING PERMIT ISSUED ............... •---- ADDITIONAL COMMENTS --- ---------DATE --- ......................... ....... t Final lnspe - - - --- - --- - i -- ---------------------Date ------ f� SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M