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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .'........ (Complete in Triplicate) Permit No. 7 .: .... ...... a .......... Y _ * i This Permit Expires ] Year fromDate Issued Date Issued .t2T_ 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 mode in compliance with County Ordinance No. 549 and existing Rules and Regulations. JOB ADDRE ......A�Xczr ' S5/LOCATION ........................CENSUS TRACT Owner's Name ........................................................ ' Address ...............••........- y .// Contractor's Nome - . .... �.--- �-"=------..license #,r��'.��.�.. Phone Installation will serve: Residence ,JEYApartment House C❑ Commercial❑Traller Court 0 Motel ❑Other ................ Number of living units:..& -.--- Number ofb,,droom N_""�- Garbo a Pinder - ._:. Lot SizeWater Supply: Public System and name __pSand �r.... ........ - --------------------....-. -_---_--- ------ Private ❑ Character of soil to a de th of 3 feet:'- Sand'❑ $ilt❑ Clay E] -peat ,tandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ^ Fill Materia) ...._,� If y ;type -- ----- -�- ---•-- " es _ �t (Plot plan, showing size of lot, location of. system in relation to wells, buildings, etc. must be placed on reverse side.[ NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ) SEPTIC TANK[ j ,�'/ ,�' S�z .�________________ _ .................0 ' �� •-••- • ----•_-- --._.... liquid Depth Capacity . Material...................... No. Compartments :. ..._._..:_ Type ................... Distance to nearest: Well ....................................Foundation ..... Prop. Line :F LEACHING LINE ' Na. of Lines __... __ ...... Length of ach ne.__...:�f'�- - �..:.._:-Total-length .__._. _..._ ... . I 'D' Bax . Depth Filter Material �-:{�Type Fitter Material � � � Distance to nearest: Well 1r6<_•a . ._ ... Faundat€an Pro a Line 'r/ F - r � [ ' Depth ..... Diameter Diameter ,� ------- Number ...----�- C3..-----..�.. Rock Filled Yes �' No SEEPAGE PIT I water Table Depth t A ------ e .......................Rock Size ..,� G � r Distance to nearest. Well ... .. __.... ...... Foundation ._ Prop. Line .... 9 REPAIR/ADDITION(Prev. Sanitation Permit# ...----•.-_........................ Date Septic Tank (Specify.Requirements) ........................... .... •--.........- ............. �- Disposal Field S eci Re uirements) f --------------•-- ...... . r -•..............................._----_ •. � .................--------------------------------------------------------------.....................................-.................. .-..... . 1 (Draw existing and required addition on reverse side) --------------- .___...._..._.._...-........._.. 1 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. Home owner or licew 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'Compensation laws of Callfbrnia-,"a►, 1 Signed ..... --------.--------- ......... Owner i ' _�. ..............................•--.... Title .... -* %` '.. If a=le, owner} R DEPARTMEN USE ONLY APPLICATION ACCEPTED By .C;; PATE ---- r-• �� 77. BUILDING PERMIT ISSUED ..................... DATE -_..___._._.,.... ADDITIONAL COMMENTS ............... _ .............. .................................... .................... ....... --•---•....................••--•- .•... • -- j 1' -•--••••. • ...........Date ... .- Final Inspection by: e z- SAN JOAQUIN LOCAL HEALTH DISTRICT F w 13 24,_.,&Q e_.. Psi _