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FOR OFFICE USE: APPLICATION FOR SANITATION- PERMIT ------- Permit No: -7o =SF`-�. (Complete in Triplicate) ----_- This Permit Expires I Year From Date Issued Date issued 7w,9/:_20 Application is hereby mo 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 ADDRESS/LOCA T IO N _7.- ---/J.----.- - --- ------- - - -- -la -.-- -- ----------- i.4!�...CENSUS TRACT ------------.------_--- Owner's Name ...... �[ y4Phone - Address 1Q- TT7 - i, , --- �ytp� ---------------•---•-- Q -....... W -.License# /��3Y. Phone ---------------------------- Contractor's Name -------.� y✓�/y) C P -- Installation will serve: Residence Apartment House 0 Commercial ❑Troller Court 0 Motel ❑Other . - ......------- -....... Number of living units:.... Number of bedrooms .___Garbage Grinder ------------ Lot Size _-__-______--_ Water Supply: Public System and name ...------------------......___---------- ......-..........----------------------------------------Private Character of soil to a depth of 3 feet: Sand[] Silt❑ Cl ❑ Peat❑ Sandy Loom ❑ Clay Loam,j Hardpan ❑ Adobe . Fill Material ------------ If yes,type---------------_________.__ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc._inust be planed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ) SEPTIC TANKT ) Size................._____..._._.. -- _..._._- Liquid Depth -----------__.---,.-_. Capacity ------------------- Type ------ ..........'-. Material------------------- No. Compartments -- -� Distance to nearekt:.Well ----------------....................Foundation _-------- --------Prop.Line----- -- LEACHING LINE [ ) No. of Lines _______________________ Length of each line-----------_--------------- Total Length 'D' Box ------------- Type Filter Material ---------------------Depth Filter Material _..---------------—_-___- c _ Distance to nearest: Well ------.....--------.---- Foundation„...._.-.._________--- Properly Line, SEEPAGE PIT [ ) Depth .............. Diameter _ . _:[:%Number!_--'--------------------- Rock Filled Yes [INo[] Water Table Depth -------- ---------------------- --Rock Size -----------------. -------=- Distance to nearest. Well -----------------------------------------Foundation ---_----__-__-_. Prop. Line REPAIR/ADDITION(Prov. Sanitation'Permit#-----------------------------........--- Date --- -------------------------) i Septic Tank-(Specify Requirements) ------------------ ---------- ----------------------------------------------------- ----------- Disposal ---Disposal Field (Specify Requirements]------------___________--------- _______ - ,ILL :X2 ------ ---- -------- - --- ...... . ----------------- ---- ------- ---- - -- ��{ (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.Home owow or lioen- sed agentssignature certifies the following: "I certify that in the performance of the work for vAtch this permit is,issued, 1 shall not employ any in srrdit rara+rr+er as to become subject to Wor an Compensation Taws of California.” Signed ---------- ------ ------- -- -- -- -_-_-�--/� ---. Owner _ I ------�----------------------------------------- By - (if other than owner) fOR.DETARTMGNT USE ONLY _ APPLICATION ACCEPTED BY . ..!77_ ------------------------------. DATE--- l.. -a3 7U -------- BUILDINGPERMIT ISSUED ---------------------------------- ---------- ------------------------------------...------------------DATE ADDITIONAL COMMENTS ---- ...- .. --------------------- - ------------------------- -- ---- - ---------------------------------------------------------------- --------------•----------------------- ..........-T. _ - Final Inspection by: --- S 4 Z --------•------------------------------ --------------.Date SAN JOAQUIN LOCAL HEALTH DISTRICT