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I� 1an FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ...................................................... Permit No. .7�^�o (Complete in Triplicate) ............................................ Uate Issued ../ !.�.-Jt! ;i ........ °:......................................................... This Permit Expires 1 Year From Dote Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install rhe work herein dertribed. This application is mode in compliance with County Ordinance No. 549 and existing Rules and Regulations JOB ADDRESS/LOCATIO ......... ................. .........CENSUS TRACT ... Owner's Name ........ sc ecu�¢�.... �� .......................... Phone Address o R.G.. . ..... ......G� ��..... ... ..........City .�2 .. ....................... . Contractor's Name . .Ti:�Lrs .. .... ...��:..%–A u ..... .........- <:......License ..113 Vic.. Phosle ,. Installation will serve: Residence E Apartment House O Commercial QTrnilar Court Motel ❑Other............................................ Number of living units: ...... .. Number of bedrooms ....`?.Garbage Grinder ..... ...... Lot Size .. ........................ .:.. Water Supply: Public System and name ..............................................................................................................Privatoo Charocter of soil to a depth of 3 feet: ISand[I Silt❑ Clay ❑ Peat❑ Sandy Loam (I Clay Loam❑ Hardpan❑ 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 revene side.) NEW INSTALLATiONt (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) , PACKAGE TREATMENT ( J SEPTIC TANK i J Size............................................... Depth ...:.. .. . . Liquid — Y .......... ......... Capacity Type .................... Material...................... No. Compartments ...,... ........... P . YP Distance to nearest, Well ..... ...........................Foundation ...................... Prop. line LEACHING LINE [ J No. of Lines .... . ................. length of each line .................. ........ To?al Length *......... ....,...,.... .._ 'D' Box ............ Type Filter Material Depth FNter Material .....:- ....:::. Distance to nearest: Well ........................ Foundation ............. ?roperty Tina SEEPAGE PIT ( J Death .................... Diameter ................ Number ............................ Rock Filled Yes ❑ - No [J WaterTable Depth ................................................Rock Size ................................ Distance to nearest. Well .......................................Foundation .................... Prop. Line ........._........ r, REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ..................................) Septic Tank (Specify Requirements) ..................................................................... ...r...._......................_............._.................- Disposal Field (S ify Re iremeats) . �4� 15.. .. �'. 'l4 4- �cr ...eG�/ "` _.._ .� �� .. . .. ... . .. .. ..............Ice.. ..... ......... ' :.....:.....:.. ....:................ . : (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.Horne owner of (iconI- sed agents signature certifies the following: "I certify that in the performance of the work for which this permlr is issued, 1 shall not employ any person In such manner as to become subject to Workman's Componsatien laws of California." Signed .............. n �j /�.' Owner ................... J`fi/...... ` -......... Title ..................................... (If other than owner) FOR DEPARTMENT USE ONLY a. vc. DATE .,� ' Q..:.77 APPLICATION ACCEPTED BY......�.:�..�'�t:................................ ........................................ BUILDING PERMIT ISSUED ....................DATE ................ •••••••••••••••••� """"""""""'-"•.. .................... ........................................ ADDITIONALCOMMENTS .......................................................................................... ................................................ ................. ......................................................................................................._........ .. .................................... ... ,.[ .............. i................... .................... ... ......... .... Fit of Inspection b .......r...,N........:'..� Date .. ...'........... ....................:. SAN JOAQUIN LOCAL HEALTH DISTRICT 13 2G 7/723 M E.H. i-'68 Rev. SM