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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITA i ION PERMIT _ . _. ..,. Permit No.,.-.7� S_ _�3 .... (Complete in Triplicate) - -. Date Issued......"�.. .�7 --------- _ _ _ This Permit Expires 1 Year From 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 ADDRESS/LO ION /... .. s .CENSUS TRACT Owner's Name_Name Phone... i,�) Address . /�o. .s. -!-.�2�- - . - Cit -- -------- ---------------------- ---Zi - - �•-, - Y P Contractor's Name-----.-_f _ �-P ----------- License # z,27e� 3 -----Phone-'1�GJ_�.a`��__-. Installation will serve: Residence ❑ Apartment House ❑ Commercial [Trailer Court ❑ Motel ❑ Other---- -------------- --------------- _ Number of living units: __. _. .. _Number of bedrooms _.__.._-.-Garbage Grinder __ ...._Lot Size_ '� S , ..--- ----------------- Water Supply: Public System and name _�- -- ---- --------- -------------------------------------- Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat ❑ Sandy Loam ❑ 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 reverse side.) NS- NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK (!� Size L--�- �..��..X -9i ---- ------------ ._Liquid Depth_---------------- Capacity/,.?, --•--- ... --Capacity,.?, - Type pit" ..Material_ _..No. Compartments - Distance to nearest: Well . ----------------Foundation.-Z . ---- ---..Prop. Line--- e� P.0 LEACHING LINE ["1' No. of Lines-------/------ _ Length of each line...:114_/.._-.-.- A .__..__.Total Length �. . ------------------ D' Box ._ Type Filter Material.Sl_ lie Depth Filter Material___---.__- Distance to nearest: Well - M.O-.A_ 14; SEEPAGE PIT Depth $ W - Foundation._. .. _. - Property Line-._-5----------.-a--u- --- . 3__.._-..Number -____._ Rock Filled Yes [�No Water Table Depth._ -.._��a_ --- ..Rock Size---„ 2X.3-• ------- - Distance to nearest: Well Foundation------ad ��j )n4n, -------------Prop. Line.----------------------- REPAIR/ADDITION (Prev. Sanitation Permit --_._- --.- .. Date Septic Tank (Specify Requirements)_ -------------------------------- - ) ------------------ isposal Field (Specify Requirements)....... .............. -------- _. ----_------------ --------- ----------------- ... -------------------- (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 o signature certifies the following: wner or licensed agents "I certify that in the performance of the work for which this permit is issued, I shall not employan to become ub,*ect to Workman's Compensation laws of California.” Y person in such manner as Signed ---- br�0..- / / - _.Owner - - Title .. (If other than oner) - D ARTMENT USE ONLY PLICATION ACCEPTED BY----------------- - ------- --------- ----------------------- -- -------------------------- --DATE DIVISION OF LAND NUMBER........... . .... ADDITIONAL COMMENTS DATE---- --- - ------ �. -- -- ------ - ---•- -- --------- Final Inspection b . ---- ---•----.Date..•--- EH 13 24 -------- ----- -- -/18S ------ AN JOAQUIN LOCAL HEALTH DISTRICT - 21en