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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ` / l Permit No. 7S.. �31– (Complete In Triplicate) ................................................. . This Permit Expires t Year from DatoIssued 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 Co u ty rdinance No. 549 and existing Rules and Regulations: JOB ADDRESSAOCATION ..../.t5_ 13. �. CENSUS TRACT �. ............. ............................ Owner's Name ... fL�.c.a Phone 4L�a:1 Address --..--_....� ................. City ..... 'T�4gkTP c�-_.......---........................_.....----- ' Contractor's Name ..._. r , .. nl.C..�...-----.License # ...................._•-- Phone Installation will serve: Residence&IApartment House Commercial ❑Trailer Court I Motel ❑Other............................................ Number of living un its:__._. _._.. Number of bedrooms Garbage Grinder ............ Lot Size .lam�J�.�.� ....•. . �...._. ~ Water Supply: Public System and name --------------•-•-:--------•......._.......----;......._ .......Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Cloy ❑ Peat❑ Sandy Loam 0 Clay loan Hardpan❑ Adobe Fill Material ............ If yes,type ............... ............ 1PIot 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,j PACKAGE TREATMENT [ ] SEPTIC TANK S€ze •--.zC,. ------------ --...... Liquid Depth ...W. .. .......... Capacity 12 W....__ Type PA A— Material_ r f --- Na. Compartments ..! ...........� , Distance to nearest: Well _A.rAtk .........Foundation .._C.. ____...... Prop. Line ---1 LEACHING LINE IC No. of Lines .._ _.........__ Length of each line-.A4s-.f..__._..... TotoI Len th Q� r ,!.................. 'D' Sox -----f..... Type Filter Material ` Depth .Filter Material ...L. --...................................E Distance to nearest: Well _ Z�Yi.4, .._.._. Foundation -.�..Q. __.._.... Property Line ..../...4. ...... SEEPAGE PIT tk Depth -- °.... Diameter . . .___ Number .....,2.,.-_-- , ._ /_ .-_ Rock Filled Yes g_ No Water Table Depth _.. ..` Rock 5ixe Distance to nearest: Well �.- -Lg----•................Foundation _..... Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .................................. Septic, Tank [Specify Requirementsl............... �� -......-. .. _ --_.............................•--..-................��.C� Disposal Field (specify Requirements ----- -------- -- --------------•-•----- -- --.•_..•_.......-.--------------•-•---•----...-•----------..-..-.---........_.._....---------•-- -- ------------------- -----------------------• ...,........ ......................... -------- ...............................I............ (Draw existing and required addition on reverse sidel I hereby certify that 1 have prepared this application and that the work will be done in accordance wlth San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health:Dlstrict. Homs 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 bVIf subject W man' Co ensation laws of California." Signed - a-� •----- • •--- ----------- ------- • ------ .......... Ov�'� By ------------------------- •--------------••- -----------------••--------- ---- ----- ..._.._ J'itle _.._ (if other than owner) ` ARTMENT USE ONLY APPLICATION ACCEPTED BY - ----- - DATi" .-. ------ ,� , �... _ ----------- BUILDING PERMIT ISSUED - ------------------- ----------- ------- ---------------DATE ........ ------------..................... . ADDITIONAL COMMENTS ...... . ........... .... -. 1�-- - ---------------------------- ----------------- --- -- -- ----- .. ---.-- ----------• •........ _•.--------------------....--•- ............. . ---...... . - Final Inspection by: -•----..._..--••--•---_..•-- �_, ...._._Date ��. =7 EH J 3 24 1-613 Rev. SAN JOA UIN CAL HE `L RICT 8/74 3M b