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FOR OFFICE USE: FOR OFFICE USE APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No,7 ..�_.3-s7 Date Issued.`.'-/-.=?- - - This Permit Expires I Year From 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 compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION----/ __3...7_er -_.. .Q.: - ---------- ------------------CENSUS TRACT------. .---. Owner's. Name_....- . .- ---------------- ! ,�j�, n ' � � } -- --•-•----- -- ------- Address- 3-.- . ..i� y k_ � l..,1 &,414/. Cit --.... ..._..._... . y.... P.................. -- ---- Contractar's Name License #_��5._ . --... Phonecz�S __c�-j.... Installation will serve: Residence ❑ Apartment House Commercial ❑ Trailer Court [] ,.. Motel ❑ Other---------------- - -------------------- Number --- -Number of living units;. ...------Number of bedrooms!_.. -Garbage Grinder------------Lot Size._.' _.Q.�...�(.. I L- ..... .. Water Supply: Public System and name---- - -------- ,._____..Private F-1.----... ----•---•-•------- -•--- ------------------------ -- - Character of soil to'a depth of 3 feet: Sand Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ 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.) NEW INSTALLATION: INo septic tank or seepage pit permitted if public sewer is available within 200 feet,! PACKAGE TREATMENT j ) SEPTIC TANK Size....____ ---------------------------=-----------Liquid Depth..:.:._........__._.-...-- ..J Capacity- ........ .......Type...--------- Material---------------------- ---No. Compartments--------------- .......... C�A. Distance to nearest: Well----------- ......._ ........... Foundation-..___._: . ..- Prop. Line----------------------------f LEACHING LINE. : [ } No, of Lines -----.-------......:_....._.Length of each line-------------------------- -. Total Length .. ----------------- -------- - 'D' Box............Type Filter Material.__-... ...........Depth Filter Material................------------.----------.--- -------..- � I Distance to nearest: Well........................... Foundation_----------------------. -Property Line-_---------------- SEEPAGE ..... _SEEPAGE PIT [ ) Depth------.___...Diameter---------------------Number------------------------- ...... Rock Filled Yes ❑ No ❑ 4 Water Table Depth.- ---------------------- - -....._- ------------Rock Size-..- ......................... Distance to nearest: Well-------------------------------- ---------Foundation---......-_.._..__......_.Prop. Line ------.------- - REPAIR/ADDITION [Prev. Sanitation Wt_ mit Date------------- ----------------- -------------- Septic Tank(Specify Requirementsl---- .. i. -----•. . •-------------- -- --- -------- ------------- . .-........... --- ..... Disposal Field Specify Requirements[--...L�.-.- ------ �.-�..---- �-'- �-n � --- ------ - �-'LJ (Draw existing 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, Horne owner or licensed agents signature certifies the followings "I ceif that in the performance-of the work for which this permit is issued, I shall not employ any person in such manner as to beco a ubject n_sation IaWs' of California." Signe ,... j -- ....Owner BY :----------------• ---- ----------------.:Title----.... --•---- -- 111 (If other than owner) .t FOR EPART ENT USE ONLY APPLICATION ACCEPTED BY- ------------------------- - ---- -DATE ........ DIVISION OF LAND NUMBER.:---- - :..... . DATE. ....... - ADDITIONAL COMMENTS--------- ------- --- - ...----......--------...... --•-- ----•-•. . ........--- a. ------ •----------------------- ............. Final Inspection b _ ` Date_....__--------------- 5._ E14 13 24 SAN JO - Fas 2� 77 REV. 7/7G 3M AQUIN LOCAL HEALTH DISTRICT