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FOR OFFICE USE: nPLICATION FOR SANITATION PE �-+� R, 1 - Permit No. . .7 "' 3 d X (Complete in Triplicate! _.... ............ . .... . _ / /.z 77 ,., This Permit Expires 1 Year From Date Issued Date Issued .,.................. . ................ ....................... .. . ti 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 withCountyOrdinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION � ... . . CENSUS TRACT Owner's Name t . .. ..� . � ' G. ...Phone . Phone- ...... . ..... . ........ '�Address � XZ . . 0r� City . LF tContractor's Name l � License # ILCC ?�7 Phone .. ... . .. .......... Installation will serve: Residence eApartment House f] Commercial ❑Trailer Court [] F[ Motel ❑ Other . .. Number of living units: f. ._ Number of bedrooms .....Garbage Grinder . Lot Size ... -�-... ........... PiWaterSupply: Public System and name _. .----........---.---.---. -..._.... .................. ........................--------.---------Private Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat ❑ Sandy Loam E]�' Clay Loam ❑ �j Hardpan ❑ Adobe ❑ Fill Material ._- _ .- if yes,type f(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.)( NEW INSTALLATION: INo septic tank or seepage pit permitted if public sewer is available within 200 feet,[ PACKAGE TREATMENT [ ] SEPTIC TANK /// [ Size.7� V � - ------ Liquid Depth Capacity I P'E-6 e�AA Type Matericl.;f -.,-e._ .... No. Compartments ... ,............... 1 � ! Distance to nearest: Well 1.�?-.e . �<�..........Foundation .L.C?.` " ......- Prop. Line .: . ......... --LEACHING LINE [ No, of Lines I . Lbngth of each line .q-0. 1-- -. ... .... Total Length ........ I 'D' Box Type Filter Material .......Depth Filter Material .... f..C!_........._.......... . . i . _ Distance_to_s_o_rest:. SEEPAGE PIT [k- Depth Z J-- Diameter -a_.F._.. Number . _.. �. � ....__..... Rock Filled Yes [!r,�No (:] I Water Table Depth ..._.... - r „ P _t..O..n... .. .. . Rock Size --1. �.._-J...�...... .... ----- .(9_� ... Prop. Line .....:r�r Distance to nearest: Well .__l..b.G... .._.-_.._ . ..... EPAIR/ADDITION(Prev. Sanitation Permit# - .... Date ....... . ...._................. ) Septic Tank (Specify Requirements) Disposal Field (Specify Requirements) ._ .. .. - — - - ...... ........... . . ....... .. ... . ...... . . . _ .. - .-.......... ..... F�. .__....._ _._ . _....... - .... . .......... . . .......... ... . . _ ... ..._ ... .- ..... ._ it (Draw existing and required addition on reverse side) 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. Home owner or licen- I sed agents signature certifies the following: I 'I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner I ! 'as to become subject to Workman's Compensation laws of California." Signed . . ... ........ ..... ... .. (�. . - -- - - --- ._........ . Owner ,y . _ xFy�tt J1 ...0\° 't Title �� f c fr �v _ . . . . .. ... .. ...... ... .. j (If other than owner) FOR pEPARTMENT USE ONLY APPLICATION ACCEPTED BYG +� _ DATE -3UILDING PERMIT ISSUED __- .. DATE . _.. ...... ADDITIONAL COMMENTS . ..... ........... ....... ........... ... . . .... .. Final Inspection by: .. ..rrl4 / ---- ---- ... ... ... .... Date ��ltf . ,J... ... ....... ...... ... (? SAN JOAQUIN LOCAL HEALTH DISTRICT