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FOR OFFICE USE:' / ` e / ' APPLICATION FOR SANITATION PERMIT 4 / _ I ICamplete in Triplicate) Permit No. .7 .........7 ... ; . • •••• This Permit Expires I 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 compliancVew,h County Ordinance No. 549 and existing Rules and Regulationss ff�] / JOB ADDRESS/LOCATION .-f� .. •� Ig CENSUS TRACT . Owner's Name �:Q:f1N1/ 1 �,�.I;.�►.� ......Phone Address . . ........... ... p� ....... ..--...... C#ty. T' %7--t 4 Contractor's Nam . ..- tT ................... •1� ..x4t�.-t�.l,�,l�- ,�y .. Llcense # Phone .. � .. 1'` Q -Q/-.. .�. e ..... Installation will serve: Residence[Apartment House C) Commercial QTraller Court Motel ❑Other ......................................... Number of living units..... Number of bedrooms _ ..._Garbag Grier � t Size ... ........... ... .......... Water Supply-. Public System and name I- { Z- -. 7" p s?v .......................Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay Peat❑ Sandy Loam fl Clay Loam d Hardpan❑ Adobe 0 Fill Mater#al ............ Ifes Y ,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 240 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK ] Size................................................ Liquid.Depth ..................... Capacity -------------------- Type ......_--•---------- Material.............--------- No. Compartments Distance to nearest: Well ................... ................Foundation ------- .............. Prop. Line ...................... LEACHING LINE [ j No. of Lines ............. ... ..... Length of each line-------..................... Total Length 'D' Box ............ 'Type Filter Material ......--•.----------Depth Filter Material ...::......... Distance to nearest: Well ........................ Foundation ........-.............-. Property p rty Line ...... .................• SEEPAGE PIT [ j Depth .................... Diameter- ....-._--- _.--- Number _.........................._-Rock"Filled Yes-E) .Na Water Table Depth -------- ---------- ••---------------•- -�NRock Size.................................. Distance to nearest: Well -. ---- '.._Foundation .-- .......;........ Prop. Line ........ ............ REPAIR/ADDITION(Prev. Sanitation Permit ---------------------------------------------Date ................. [ ................. Septic Tank (Specify Requirementsl. -. 4.. ---- � t Disposal Field (Specify Requirements) _ ®I ;P _ . A C� t �_ "• C- , .!•........ tt �� /• I # --•-------- --------------•---------------------------------- - (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 th rformance of the work for'which this permit is Issued, I shalt_ not employ any person in such manner as to becoe b Workman' California." ompensation laws of ; ' Signed --. . - .i- - Y- Qti� r'fC------------------ Owner ZF By ............................................... ----- (If other than owned FOR DEPARTMENT--WE ONLY + APPLICATION ACCEPTS© BY ----.- . DATE -. .-: .... .... BUILDING PERMIT ISSUED'..... ::.-.... ......•-----•-• ...�,..._. ADDITIONAL COMMENTS ----•........................ ------DATE ....`..... •--- ----...-- ---------- ---------------------------•-------- ---...--------...------•---------.-....,...--. -- C ----- Final Inspection by: .....- __ Date . Ell 13 24 1-613 abu, SAN JOAQUIN LOCAL HEALTH DISTRICT J �//7h 3M Q