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`4FOR OFFICE USE. APPLICATION ICOR SANITATION PERMIT -•_......... Permit No. ..^ ... (Complete In Triplicate) 7' .......... .. .............. .. v .. a...,-,.... t .. ...... -•••--•..............:.....I........_....._ This Permit Expires t Year from Date issued Date Issued _f,- :6.7, Application is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work herein j described. This application Is made in compliance with County Ordinance No. 549 and existing Rules and Regulations- JOB AbDRE5S/LC►CATION ---- ..__..CENSUS TRACT ....................... Owner's Name .....` /e0LU . . ..........................................:....................Phone Address ......_.._--•--:City ............: ............•••••• Contractor's Name •-- - .��T-.--�'-�--- 5;�',X .-•-----.....lioense;�,��,.�.�. . _... Phone - Installation will. serve: ResidenceZ Apartment House] Commercial 13Traller Court 0 Motel 0 Other..._... ............ ----•--•......:........ f !Number of living units.----/------ Number of bedrooms --- .....Garbage Grinder ;FAV17._- Lot Size __��,e�.��............ Water Supply: PE§ a red name ............. .Private ❑ ...----».._.. �....... ......................................... j Character of'soif,to a depth of 3 feet: Sand❑ Silt Q Gay Q Peat❑ Sandy loam 0 Clay Loam j] s Hardpan d . Adobe& Fill Mater€al I#yes,type a............... .......... (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 I ] Size................................................ Liquid.Depth .------..-------..__...--_ Capacity No. Compartments ...................... Type -------------------- Material---.......__.:_ I Distance, to nearest: Well ....................................Foundation ..__........ ......... Prop. Line ...................... r� LEACHING LINE j No. of Lines ------------------------ Length of each fine.......................I.... Total Length ............ 'D' Box Type Filter Material ....................Depth!Filter Material _ r Distance to nearest: Well Foundation ........................ Property Line SEEPAGE .........�PI.F Depth. ------_-------- Diameter ._.. :: Num � ................. Rock Filled Yes Na Water Table Depth --•---- ....... .... . ......Rock Size .......................... :. - --- - Distance to nearest: Well .'Foundation __.. -Prop. lime . REPAIR/ADDITION'IPrev. Sanitation Permit# ...: 17 ..............---•.............Date .-------.I Septic Tank (SpecifRequirements) ...:................... :-.-----..:......;.......---•--......-------:.•....---.,...._...-•--•-. -----...... :..... ..__--•-....- ---•--••- -.--r — / or p --Disposa Field 5 eci virements) ---• ........... 3_-. _� 1.1_ - ` (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 Count y 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 ollowing:"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 Compensatio laws of California." dr Signed =' - --------------------•-----• •--•----------- - Owner , BY --------------------------- -••------------- I (if other than ner) ---------•--. Title ----- 4 FOR DEPARTMENT USE O LY APPLICATION ACCEPTED BY ---• ---------------: , ..: DATE...../ 7416 BUILDING PERMIT ISSUE© --------------------------------- -_ -----------------•-- .......... ............---DATE -.............. -'--------- ..........._. ADDITIONAL COMMENTS --------------__...................... - . --------•----_ -...._ - -------------------------------- ------- ------ ._....----•------- -• -- •----•--_-••--------- -• Final Inspection by: ._-------------------- ----•---.- ._ EH 13 2?� 1-6i3 -•- -- .._tiate .. --. ��- -?-t ---_. ._. .. - ,— v• SAN JOA I LOCAL ALTH DISTRICT = $�7 3M