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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT i (Complete in Triplicate) Permit No. . .zx-7 _!/ - -- - - -............. 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 ADDRESSACCATION ....127 nr . Owner's Name ....... Hc �7 7 CENSUS TRACT ._tJ'. S..wt C�Cthfrl r J ....... .................... .. ................. ...................................... . .-- __..-....Phone .�.:..�-::.:>'.3..`.t'.t`.._... Address _..5.1 a H .... .................. ................... city .-._... Drs... Contractor's Name .. .......... . . �ax. . Phortai ...� -- ---..... Lienee * installation will serve: Residence AApartment House Commercial (]Trailer Court ❑ Motel ❑Other ............................ Number of living units..-_._ .. Number of bedrooms 3.......Garbage Grinder .... Lot Size ...:�.f ...... ...........---..... Water Supply: Public System and name -_...................... ....Private ♦ Character of soil to a dept.. of 3 feet: Sand[) Silt O Clay 0 Peat Sand m Loa0 Clay Loam EK Hardpan Adobe © Fill Material ............ if yes,type ............................ !Plot pian, showing size of lot, location of system in relation to wells, buiidings, etc. must be placed on reverse side.) NEW iNSTALLA71ONs (No septic tank or seepage pit 1sermitted If public sewer is ovailobl within 20C -eet,) °A-KAGE TREATMENT 1 7 SEPTIC TANK t J Size....--- ---••------------------- -------------- Liquid Deptr .......................... Capacity .............----- Type ...'............. . Material....------------------ No Comportments ..................._. Distance to nearest: Well .... .................... ..........Foundation ...-•-.... .......... Prop. Line.---..............._. LEACHING LINE [ F No. of Lines ..........._.. ngth of each line ..._.............--....... oral length . ........................ 'D' Hoz ........- Type Filter teria) ....................Depth Filter Mo 1101 ............................................ Distance to nearest: Weil ...... ................. Foundation ..................-.. . Property Line SEEPAGE ?ET j Depth .- _ .............. Diamete ................ Number ----- .......... Rods Filled Yet ❑ No . . Muter Table Depth . ............. ................................pock Size .......... Distance to nearest: Well ...... -----------...._.............Foundation ........ Prop. Line ........--.........-. REPAIR,'.aDDITION(Prev. Sanitation Permit$ .............. Dote ................ Septic Tank (Specify Requirementsl .............. -- Disposal Field (Specify R asst .. Requirements) .......... p r c 44 ::.. ... ..... ::.X. .S- f%�-.............-....-... ............I......... .. ..-.----...................._--- ------.................. ---.......---............----••--- -•-•---•--•-. ..................... . ..__._. ♦ -.d.e.........................._.. .._ ...._............ .. (Draw existing and required addition on reverse tidal C hereby certify that have prepared this application and that the work will be done Ir- accordance witr ;or .oaquir County Ordinances, state Laws, and Rules and Regulations of Hee San ioaquin Local Health District. Homo owner or ".icen- sed agents signature certifies the fallowing: "` certifr tha+ 4n the nerformonce of the work for which this permit is Issued, P shall oat employ any person r :ucr manner as to becomes t to Workmar'v Compensation lawr of Yalifernia." Signed . ,. Owner BY ...... Title Of other than owner) _4....................... ............. .._--_. r FOR DEPwRTMENT USE ONLY APPLICATION ACCEPTED BY ...-- tf;. ... _............................................................. DATE BL4LDING PERMIT ISSUED ............................... . .. DATE ....................... .......-. . _. ADDITIONAL COMMENTS ................ a- �Z- ...................... ---••----------- ----------_.. .....................--------------..--........ . - ... ................... .---------- _.. ... - .... -----;r-7, : :::::::::::::� ::: ::1J= : :: ::::. y SAN JOAQUIN LOCAL HEALTH DISTRICT 3 24 ,.•Ao ems.. caa