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FOR OFFICE USE: f APPLICATOW FOR SANITATION PRRMTT -, , Permit No. . 7 .......... i ---:a'..1Cornplete in Trlpllcatel z_ ,4. , . .......................................................... 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 compliance with County Ordinance No. 549 and existing Rules'and Regulations: JOB ADDRESS/LOCA' ON':fa�Il VI_./ .. V-10. 41 :T.....CI:NSUS,�TRACT ��/ !! .. Owner's Name ... D_�r41 ---�i� ..........................:..............................I........... Pha ne I Address f :....... ..City ....�d l4?� 4.!f ................. ---------- Contractor's Name .. �.. A7c�� .._1 � `... -:...........License#�.3`7 1 Phone ..3 .��'�� r .Installation will.serve: I Residence FrKpartment Housef3 Comirfircidl-j_]Trailer Court ❑ i . ._ .� Motel❑Other •.._ .--••.................:........ Number of living units:---.._.:----- Number of bedrooms _-7-----_-Garbage Grinder ........... Lot Size ....... ............... j Water Supply: Public System and name. -------------------- .... . .................... Private-@-- �- F Character of$oil to a depth Of 3 feet: { Sand E3 Silt❑ Clay 0 x Peat❑ Sandy Loam 0 Clay Loam 12�-� Hardpan 0 �.wAdobe❑ Fill Material ......... if yes,type......... .. ............ 4 IPlot plan,showing size of lot, location of system in relation ta-welIs-,,buildings, etc..,must�be placed•ari reverse side.) NEW INSTALLATION: (No septic tank or seep s Hifi permitted i public;, r-is available within 200;feet,} ~ M x -- ---PACKAGE TREATMENT ....... . . .---- -----... Liquid Dpth Capacity Mtrial •� - _ lky i Distance.to nearest: Well .Foundation .::'; ... ;----- --- Prop. 'Line ---..... 1 LEACHING LINE [ ] No. of Lines ------:�........I...... Length of each line .... ... - Total Length . ........... ' `D'. Box ............ Type Filter Material .........,..........Depth Filter Material .......:......................:............ f Distance to nearest: Well ---------------------L Foundation ................ Property Line ........................Z 4 SEEPAGE PIT Depth -------------------- Diameter ................ Number ------------. .............. Rock Filled Yes (3 No 4 Water Table Depth .. ..Rock Size ................. '�i Distance to nearest- Well .. .Foundation ..................... Prop. Line REPAIR/ADDITION(Prey. Sanitation Permit# ....... --•...............-.................. Date ....:.............................. Septic Tank {Specify Requirements) --- - -• !�� .=. 1- � - ..,.__ Disposal Field (Specify-Re uiremen.ts`).. �a ......_... .......... Ze, _..... ................. .� ...... ' 4 �*------- ------"-"--•-------- ! ......_.__.' ------------------------------------ - -!--------------_._. - - -•------. - --.-.------------- -- ......_... ....................... ______................__....... i Draw existingand 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 the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed -----... .. ........... .------ ._...------- • .-... Owner _ - > BY -�------••-.. � ----------------------- ................ Title ---�ht1��.-- •-- -.�. ..... (if other than owner) R DEPARTMENT USE: ONLY ' APPLICATION ACCEPTED BY - --"...:............................................ DATE BUILDING PERMIT ISSUED .......................... . .. ..................: •..--•---••.-••---........... ....................DATE - _...-........ ADDITIONALCOMMENTS ......................................•-•-•----•-----•----•--•--•---•----•--..------..........I-------...:------•'---- •--- Final Ins ectian b --- •------------ --- --- .......... .............. ............... p Y Date .. .-. .Zti- ... ...... 1-68 •'. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M