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FOR OFFICE USE: 4 1' APPLICATION FOR SANITATION PERMIT ........................................••-• Permit No.�a�:. . IConfplete in'-Triplicate) ................ � )�-- Date issued ....—.......:....... .................................................. This Permit Expires 1 Year From 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, 544 and existing Rules and Regulations: JOB ADDRESS/LOCATION ....,7,3'0_�.V...............�}��r�a- .5_._...:.:;ST-,_..:.:....._ ...... TRACT .....` ..�--_.-.. 1� Owner's Name .--08//4...... �. ............... ............ Phone 7 .. .... Address ._ ,} . -------- ------- ........__. City _ TQC .. ............... ...... ...:. ......�G �f �� > / ... Contractor's Name ./�' ... f-/ r�C"..1 {/may --------License #17 .. Phone� �,1� _. .. ry I Installation will serve: Residence o Apartment House 0 Commercial }]Trailer Court 0 Motel ❑Other ---..........:............:.:............ : . . _.__.. Number of living units:.__...... Number of bedrooms .-.2".-....Garbage Grinder A10.... Lot Size ........... •--•• Water Supply: Public c System and name -------------- _. -------------------------------------- ..----••--•------............. -•.Private ❑ Character of soil to a depth of 3 feet: Sand 0 .Silt❑ Clay ❑ Peat❑ Sandy Loam p Clay Loam Q Hardpan ❑ Adobe Fill Material _.. ........ If yes, type ----------------............ (Piot 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 ] f Siza...� X... !..................... Liquid Depth41_.._.._.........----• Capacity ./rp?Aa....... Type�.�AMaterial�ll�_MG_,�' Na. Compartments ��....`.......... I Distance to nearest: Well. ._ ...............:;.::..Fou nation .,�Q :...--------- Prop. Line .. .....___...... ID . - .rte: ,..� LEACHING LINE RJ No. of Lines . Length of each line.-_/Q . .............. Total Length /P:l'.....---... S ....._. 'D' BoJ ;eVO.--- Type Filter Material IPOCJC. Depthk Filter Material ....1.. ..`�........._ ................... �Q r r /' Distance to nearest: Well .....___...:............ Foundation ...._...__•........:.... Property Line .47./...... G SEEPAGE PIT j Depth ..c. ....... Diameter .. Number ...... ........`.... Rock Filled Yes..M No 0 " •� r • Water Table Depth ._ti.JQQ.__.--_. ........Rock Size 1h'.r...X.1 . O9 Distance tonearest: Well .-� ...........................Foundation ./............... Prop. Line to .. ........... REPAIR/ADDITION(Prev. Sanitation Permit# _.......------------------ ................. Date ........... .--------••-• -} - Septic Tank (Specify Requirements) E DisposalField (Specify Requirements) ---------•--•-----••-------------------------------------------------•---- -_.-.--------------------_----.....-----• i •--------•-•----------------------•---........--------.-.-----------•---••----....._----------------------•- ----_------ .._... ........ ---------...__.......•--------------- ------------------------------------------•----................... .......................................--...............---.......................................................................... f (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. 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, I shall not employ any person in such manner as to become subject to Workman's Compensation -laws of California." ) SignedZ .... . ---•--...----- Owner - ............. ,o.� /ner .. Title . c.11 0 ..............Sy ..... .............. .. .. / -(If otherthan t t FO >E:PARTMENT USE ONLY + APPLICATION ACCEPTED BY ....................::M........._....._....... DATE,l... p ...7... ........------. BUILDING PERMIT ISSUED ................. . -- .DATE ................1-1. .... ADDITIONALCOMMENTS ........................................_ --.----••---................................... I............................ ...................:........................... &0 .......................-------------------------- ......................................................................... ............__••_._._____...._....................................................... _ _.. .�. . .......�':F Ji: -_....... •• ................._............ .. T ._ .... ...:..:..... ....yy .�- ...............I........... Final Inspection by E� •---------------------------- ------------•-•............---....:. .;Date _ ��. .._.._.. ..... .�� SAN JOAQUIN LOCAL HEALTH DISTRICT k _ .. �c. . .,. . �.. 7172 3 L,4