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FOR OFFICE USE: APPLICATION FAR SANITATION PERMIT Permit No. 7 ......................_.. .... (Complete in Triolicatel . ........................"......................... Date Issued 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 'nstall the work herein described.This applicatior is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: !2^...CEN {. . SUS TRACT -y -- 7....... ..... JOB ADDRESS/LOCATION �� s o �Rar�'�"'"•".�`'-.. _._....... � Phone Owner's Name .r.e.1.,........... 1i1!L. -rsie................................................ . ...._. ..." - Address ...._. �........Ci _ .�e.d.i_._._....... Gr ... .. ..... '�/C�v .... . hon . $.3 X - �. 3.1.8_x, .."....u./art.... ..........: .. .............. .... Contractor's Name ..._. .. ..."L'.//�..WrE'SArt°�..3RA!1�T/.1�rr!•rr-..Cicensa # .I _7. ...Y.. Phone .. .. ........... . Installation will serve: Residence RApartment House❑ Commercial ❑Trailer Court a Motel ❑Other ......."..... ... .......................... r / Number of living units: .A...... Number of bedrooms ..'3......Garbage Grinder .. ........ Lar size ....... 5... .. .....fo.�.J... . .........................Private ' . ...................... . Water Supply: Public System and name ................................... .................. ...... Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam C; 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.) ij NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) t/t SEPTIC TANK[kj _......._....... ..._....._ ... Liquid Depth .................. O PACKAGE TREATMENT I ] //JJ / No. Compartments __.. MateriaL.l. e Capacity ]_sf2 a.._ Type .. . "". " r i J Foundation _.1+. ..._... Prop. Line ...L..b.l.....-.��. Distance to nearest: Well ..."..../. .. .. p i LEACHING LINE [Y] No. of Lines ......`•Z.._.......... Length of. 1each ,�IIIII a / O'_.... ..._ Total Le,91h ....�-.-R.O......"..... 'D' Box ...es<.... Type Filter Material LCAa�--[TV Filter Material /17-11."- .....�'j t o ........ Foundat;on .. Property ............."... Distance to nearest: Well ....q.0. �............. ro r Line .... - Number _. `. ....... ...... Rack Filled Yes JP,I No [] SEEPAGE PIT f,+.( Depth 5.........- Diameter ' gyp ..........Rock Size ................................ Water Table Depth .._.._.`pare...-- -- e-' Line ... �...."................Foundation A.a.0....... Prop. �.,1............ Distance to nearest: Well .....1..7.�� REPAIR/ADDITION(Prev. Sanitation Permit# ............................ .... Date ........................... ) Septic Tank (Specify Requirements) ....._...._..................................__....................."............."......_........................._..............."... - .............................. Dispose) Field (Specify Requirements) ................................ ................................................... (Draw existing and required addition on reverse side) I herby certify that I have prepared this application and that the work will he 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 parson in such manner as ro become sublect to Worljman's Compensation laws of California." Signed � i�i4...c...... ....._ Owner _. -- ��- .. By (If other than owner) FOR DEPARTMENT USE ONLY — _ DATE ...... ........... APPLICATION ACCEPTED BY ,..DATE . BUILDING PERMIT ISSUED . . -. . .. .. ... . .. .._ __.. . __.._. .. .... . .... ..... ADDITIONAL COMMENTS - -- _ ... ._ .... . _. . . . ate f ; / Final Inspection by. / .. -- . ..... �- SAN JOAQUIN LOCAL HEPLTH DISTRICT