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FOR OFFICE USE: T -........... -- ......... - O 6 APPLICATION FOR-SANITATION PERMIT (Complete in Triplicate) Permit No. ..7�_ S7G " '"' ..................... - �-.-- 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 rdinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION Owner's Name ... .- ------- -- - ------- ------..CENSUS TRACT .....�(�--.-......... - Vie . -. �.d -- - ........ - Phone ....Address ...---v ....... ......... -- ' �/'-- ----------* City a� t, Contractor's Name . .mac.. -%+rJG/Ems, 1------------------------------------•....`. 6L- ----------- ---- -......License #�GlZx92...... Phone Installation will serve; Residence ®'l�artment House0 Commercial E]Trailer Court Motel ❑Other - -- ----- - - umber of living units:.... ..... Number of bedrooms .- .--.Garbage Grinder .V�� Lot Size _ Water Supply: Public System and name .--_ Character of soil to a depth of 3 feet: Sand Sil ----_Private. t❑ Clay ❑ Peat❑ Sandy Loam 0 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.) NEW INSTALLA'T'ION,LLATION, (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ) SEPTIC TANK Size�� __ //// �' -X --- -X-Ea..... - Liquid Depth b�� -------------- Capacity _7WQ. Type� 4g ,/� _ Material- ` + / _ /� I•-l�+'/ems...... No. Compartments -................ Distance to nearest: Well _------ - � ------•----- ..Foundation gip--- ------ Prop. Line .01 - + LEACHING LINE No. of Lines .-.....Z _.... Length of each lin ......R4-.-__.-, - Total Length // I 'D' Box �- Type Filter Material/45 Depth Filter Material L _.-_---- r�------------------ Distana to nearest: Well / � f�----. ----- Foundation .. - �-..-------._. Property Line .-ye?' ----....-- SEEPAGE PIT Depth .,ir�..-- Diameter ��._--- Number ..... .. -- - �---.-.---.....- Rock Filled Yes ' No ❑ Water' Table Depth ..._...0;� .�._.-------------------_-Rock Size Distance to nearest: Well ;_4 W-----__-.__----- -- _Foundation --.� ,-.-... Prop. Line _I.0-........... REPAIR/ADDITION(Prev. Sanitation Permit# .............---- ------------------- Date t....... Septic Tank (Specify Requirements) ---------------- --- ---------------- isposal Field (Specify Requirements) ......................... ----- ----- ------ --- - - - -- - - -.......---- . --------------- -------------------------------------- --............................. ---- ---- - -------- -------------------------- ------ ............... ---------- -... ------------------------------------- ---- --- - (Draw existing and required addition on reverse side) 1 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- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's CompW ws of California." Signed - - - Owne: By ................. - - ) .._ ------ --------------- Title -- - -- - (1f other th owner ��tt�-- �...^.._..........-----------...--- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY �- �� / - ------ -- ....- - - DATE ._.-._�5. .^J......................... BUILDING PERMIT ISSUED ------------- --------------------------------- ----- ---------- . ----------- ----------...DATE ...._.... A DITIONAL COMM S` - - ----- ------------------- {�.-ar t ------------------------------------------. . - --- ------ . . -- -- ---- --------- -....... . ........ Final Inspection by: -..... . - _. . .. -------- -- - ---- --- - -- ---...........Date - Y - _ SAN AQUIN LOCAL HEALTH DISTRICT