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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT permit Na. -7 s.............. '.................................. ...... l.Campletein Triplicate) t....................... . k �r {----- Date Issued . .�...7f... This Permit Expires 1 Year From Date Issued E 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/LOCATION ,--------- ------- -------------- CENSUS TRACT .... :............ .. • --- 4' - -Phone .........................:........ Owner's Name ......... ------ _...-•---- ----• City .... Address .._... •--•--• Y - - -� ,n ......... Ji., c�.�Cl!__ r4'scense o `�_ _ Phone Contractor's Name -!�cr[�-- -- Installation will serve: Residence Apartment House[] Commercial []Troller Court [] Motel ❑Other ... ----•--- - -- ------- -. 1 i �-_ Lot Size .. moo.- .. ......_.- Number of living units:....... Number of bedrooms _ -r.---Garbage Grinder .... Water Supply: Public System and name ------- r ... .............Private ❑ Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam El Clay Loam [3 Hardpan ❑ Adobe Ae 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 INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK r Size. ........ liquid Depth ._S ....... s...•....� Capacity/�006W,4' Type•�Moteriol No. Compartments .11),...............t.» i : Foundation . Q.-..r-._..... Prop. Line _.: _•.._......0 Distance to nearest: Well • - r~ LEACHING LINE � No. of Lines --- .... Length of each line .AZAR • Total Length/ -9 ..... `�----•-•-• r D' Box .. ,-.. . Type Filter Material ./ _..Depth Filter Mater':al ..-L�� --....-- f. '� / ;. Distance to nearest: Well ,.)Ia Foundation 149------ ....... Property Line _... ••--•--•-•••• r SEEPAGE PIT [ Depth 1-4 ----- -, Diameter .2_ ..`,P._ 'Number . ...`- Rock Filled Yes ( No ❑ ----•-....Rock Size .__.CX. ---........ •-- ..... O Water Table Depth _..... .. ,,--``.-- ...... .. `o _._ .. r Distance to nearest: Well / -. -----•--Foundation ...Z ------ Prop. Line .. ................•� } REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------------------...---..•. Date -----------........._1------- Septic Tank (Specify Requirements) ... Disposal field (Specify Requirements) --------------------------------------- ........... .. ----- ----------- --------------------------•-............. ..--------•--- -- -------•-- ' (Draw existing and required addition on reverse side) I I_i, reby certify, that I have prepared this application and that the work will Ise done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin (Local Neoith District. Home owner or licen- sed agents signature certifies the following: f "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 California." Signed ..---... ------- Owner BY -7 Z�_ Title ..... . ....................... (If other than owner► Fet DEPARTME LiSE ONLY APPLICATION ACCEPTED BY .... DATE ... ".�. BUILDING PERMIT ISSUED ------ - • DATE .. `..- ..__......_._.._. ADDITIONAL COMMENTS ............................................ ................. ------ •-- .----•-- ------------- - -------------------------------- -- ---•--. ------- .........._...--------. ......... ............ - --------------- -- Final Inspection b Date -- ....---- -• p y. .._.. SAN JOAQUI LOCAL HEALTH DISTRICT /. L, I3 -24 ,_-AQ a.., SlUI -7.2 3