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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7 y/ 33 7 - Permit No. ------•-•.'•--_--•. (Complete in Triplicate) A Date Issued .� :� .7 ........... ........ This Permit Expires 1 Year From Date Issued . ... Application is hereby made to the Son .Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with7`C6unty Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOC TInON ��.��. °...... CENSUS TRACT ............. Owner's Name ... .. ------ .:..:.........Phone .................................... k Address 1 ......... -.-------- .................. City ......L A[................. ...... . ..... ..... Contractor's Nome ----- �y�.�.�? '_. �:.._ *'_* � _. ,'_:License # . Phone Installation will serve: ResidencerAApartment House❑ Commercial :❑Trailer Court•0 Motel ❑Other ...................................... ...... - Number, of living units----- Number of bedrooms........3 ..... Grinder ------------ Lot Size .......`.......................... ........ Water Supply: Public System and name ........----------------------- -----------------•---......................................._............Private Character of soil to a depth of 3 feet: Sand Silt❑ Clay Peat❑ Sandy Loam ❑ Cldy Loam C] 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.j NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is o4dilabte within 200 feet,) PACKAGE TREATMENT [ ) SEPTIC TANK'i ) Size....::............•-•.....................:..... Liquid Depth .................. Capacity .................... Type .................... Materials-':.-—...``lNo. Compartments ................ Distance to nearest: Well .._._._..!.....................):.::Foundation ...................... Prop. Line .............. LEACHING LINE [ ) No. of Lines ro........................ Length of each line! .... Total Length ___....__.. ........ V Box ...........-. Type'Filter Material :..............i=Depth Filter Material '-.-. ................... ........ Distance to nearest: Well ......:.:}.....' ..... Foundation Property Line-......................• SEEPAGE PIT [.) Depth .................... Diameter ............... N mber ................... Rock Filled Yes ❑ No • Water Table i DepthR ......... ....Rock Size Distance to nearest: Well ........................................Foundation ........... Prop. Line ..................... REPAIR ADDITION(Prev. Sanitation Permit# _............_..............................Date...,._.....:....................... ) Septic Tank (Specify Requirements) ................... .................................�:: � ...... ---..._........ ,..............................__._.. 1- 9 J Disposal Field (Specify Requirements) 4 .a. -. /� ••--- ! - �. �x� ��'._....--- .. ...-.•• r7+ rd`+-. � " torr-••• ..••.• r*x ........... ------•--- _-s-._... ...............................----------•---..: --.--------------- =----._:_.............:............::__...-- (Draw�Aisting 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 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 Wor n s Compensation laws of California." Signed .... --------d----------- �-- eOwner By ..................................... . !'-... t><- --4, -, 5itIe ...... ... .................. (If other than owner) I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY !Y? ---------------• --------..._............ ......... DATE .........-- BUILDING PERMIT ISSUED •------------------------=----------------------- ............ = --......• DATE ........... ..................... ADDITIONAL COMMENTS ........................................••......,........................................... ._._... .. , ....................................................... ... j ......... .............. ....._......._.... ___... ..__..•.......... ...F_'_....�............. .. _ .... _ ___._....-•_•_____• ........................... _._..r.............. _ ......._._......._................ .............. Final inspection by: .._..... r� r .-----•----••................•--........---._... ......---....Date ' ....: z --•-•-•--------- SAN JOAQUIN LOCAL HEALTH DISTRICT r 4. &:H_13 24 1_,AA RPv. SM 7172 3 M