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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT ....-•-•.......................:....•--•-..---- Permit No. 7 4��-�/ (Complete in Triplicate) ................ ...........•........................................... This Permit Expires 1 Year From Date Issued Date lssued .f � Z. 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 . . ?. .. ._. .-- �Q.•--, � !+•!f _ CENSUS TRACT -----•............................ Owner's Name �Xk.... .Ao_� . .......Phone 1-6.3":t.. s... E Address .0- 1�...0- .:_ ty ` '�....................... .... ci . . 1�....................... ----------------•--------- 15�Contractor's Name ._. _�.. ,�..[ ----------------------- - ---------•-- ----- ...i.ioense # _1,T].-AAA Phone .bbl._-AIA3 Installation will serve: Residence['Apartment House f] Commercial QTraller Court Q Motel Q Other---•---•--•---------------.................. .�... i Number of living units:_trv%P__ Number of bedrooms ' .......Garbage Grinder .......__ Lot Size _99� eAZ4#t.................� Water Supply: Public 5ysteri} and name .. •.._ ................_....----..............................-----.:.'.......Private Q Character of soil to a depth of 3 feet: Sand Silt p � ❑� Cfay [} -Peat❑ Sandy Loam_fl Clay Loam Q Hardpan p Adobe Q Fill Material ............ If yes,type I (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...�.�.1_.e j2...50.....•_...._...... Liquid Depth .. .. __......... Capacity 15Qj0_-gd_L`__- Type YP - ------ Material......__............ No. Compartments ___...__......... Distance. to nearest: Welly, -o�� Foundation -4Q-1---------_ Prop. Line .��.�.........._. LEACHING . LINE ] No. of Lines 01..................." Lengt o each line...7{j.'.-.._._........... Total Length .j6"D..1 U 'D' Box .1......... Type Filter Material 1j.?aCkDepth .Filter Material ...................... Distance to nearest: Well ........................ Foundation 3o................... Property Line I.D_................... 1 SEEPAGE PIT [ Depth __j Q............ Diameter _W.�(V... Number ................ Rock Filled Yes {X No Water Table Depth ................................................Rock Size ............. .................. Distance to nearest: Well ........................................Foundation .................... Prop. Line ---------........ REPAIR/ADDITION(Prev. Sanitation. Permit# ............................................ Date ._....._..... .................... F SepticTank (Specify Requirements) ............---•................................... ....... .....................---........................................................ DisposalField (Specify Requirements[ ------------------------------------------.................... ------------------------------ ------ -----------..........---........ ------------------------------------I....... ------------------ ....................... -- -- ----- (Draw existing and required addition on reverse side) E 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 (i".or or licem sed agents signature certifies the following: "I certify that in the performance.df live 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." l ;l Signed ------------- ------=------------------------ ----- f ..... `... Owner By ------------------•----------------- - --• --- ----- -- Title ---------------- ----•-•---- ...--.-----.----------------------------- (if other than owner) . DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- •--• ----- - ---- -•---- ------------ ----- ~;= DATE - -------- BUILDINGPERMIT ISSUED ------ ----------------------------------- ------------- --------- -'_.._....-- -----------DATE ............... ------ ........- ADDITIONAL COMMENTS ------•-------------_----- .... - _ --------- ----------- ••------------ ------------------•-------•-• --------- -----. •---------------------- -- Final inspection by: ....... - --- -----------.----....-- ----...._._..---------------Date _ Elp 13 2!t 1-6$ F� SAN �OAQUIN LOCAL HEALTH DISTRICT 3M