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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT 7 -------..._.1.x.:3.°----- ........................ Permit No. (Complete in Triplicate) Date Issued Al .- .......................................................... . This Permit Expires ] Year from Data Issued 5'7V 'I Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein ' described, This application isr a in compliance with County Ordinance No. 544 and existing Rules and Regulations: JOB ADDRESS/LOCATION .:...CEN5l1S TRACT .f 4(�•.... s Owner's Name ; .............................................................. 1 .............Phone ............. .........:.._....... ..... Address �. __ --- `" TT --------------------- •.... �. ... :.. ......----F ------•--.... City Contractor's Name License # �. J ." � , �/� �i1r-_--------- •--•-.. L$7f., Phone ,if�At��:.:./........ ' Installation will serve: 'Residence Apartment Houser] Commercial ❑Trailer Court 0 Motel ❑Other got .� Number of living units .. : ./-_--- Number of bedrooms .....:i.Garbage Grinder /,�/f�.... Lot Size 4 . Water Supply: Public System and name Private, Character of soil too depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam m Clay"!oo�n ❑" 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: {No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK ] Size.................................. ............. Liquid Depth 1......................... F Capacity _....--------------- Type •................... Material....................'----No.-..Ccmpartments ............:........._ Distance to nearest: Well .Foundation ti Prop. Line ' ..- -` LEACHING LINE [ ] No. of Lines n...................... Length of each line..._:........_.......:....:-.'..Total._Length ------------- . 'D' Box .........v., Type Filter Material ....................Depth .Filter Material ............................................ � k Distance to nearest:. Well ------------------------ Foundation ...............-._...... Property'Line ._........ ............. - r SEEP, AGE PIT Depth Diameter ..._..__.._. Number ............................Rock `Fi.lled._Yes 0 Nb Water Table Depth Rock Size Distance to nearest: Well :.---•'.................................Foundation .................... Prop.-•Line ....................... REPAIR/ADDITION(Prev. Sanitation Permit# ---------- Date Septic Tank (Specify Requirements) _---------- -------- •----- ......... ------ . ..........._....--•• f Disposal Field (Specify Requirements) f _ ---- '---- tp/ loff__- --.-- ?. � ---.. 1-� -- .. ....... + (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 Ilcen- 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 Workman's Compensation laws of California." Signed --------------------• - ----------- ` Owner oth fir f Z I F R DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY -... DATE ./0.--2 BUILDING ;PERMIT ISSUED ........... --•--------- ---- .... ......DATE .-..--- - •------- _.. ADDITlON4L,COMMENT5 ......4SAN ------------------ ------------------ ------------- -- : ...-- - -.;. _ ._�._._..-- `. -�.f �......`... .. ... :Z�:Final Inspection by =' Date - - --EH 13 2h -di3 2dev. 5M JOAQUIN LOCAL HEALTH DISTRICT �7l� 3M a 1 5