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,. -FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. .,.75:: .._.. ..::.............. !Complete in Triplicate) .,.. .. ............. ............................••__-•.. _This,PermitExpires.t_Year,.l=rout Datslssuee!_. flats 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? ---•• .... ..... _�_....- - - - -F'�.....................CENSUS TRACT ........... a , Owner's Name -------- -- . .. 7�t -+ •--- .........._ ..... . one ..._..., : Address .-- :._..._. �/ ...... Ph .c' ?S.. _ ice , ...._.... City ... ..._..... Contractor's Name __-. i t--. ... &N ..............�^e �a ..... license ............_...._-•---• Phone -- --•---...:� ....Z_ Installation will serve: Residence OApartment:House 0 Commercial❑Trailer Court ❑ Motel ❑Other ....................... ...:........ . Number of living :units:- 1....... Number of bedrooms ..,I.....Garba_ge Grinder ........:... Lot Size � ............ /J ` ..5..._.......f _.....�..L.......... d Water Supply: Public System and name } r-•=------•---•----.....__.�_...._...................................................-1 Character of soil to a depth of 3 feet Sand t] Silt❑ Clay ❑ Peat❑ Sandy Loam❑ Clay Loarn ' ti Hardpan{] Adobe Fill Material ............ If y. es,type (Plot plan, showing size of lot, location of system '!n 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 C � � �ize__, ---•-----•.................... Liquid. Depth ............. Sj fDCapacity __�s�"�-Q-..-- TYPe • A!==-�_�=._ Material---l.�---:---•---- No. Compartments ...................... tA Distance. to nearest: Well .. ....................Foundation _ l ,. f . � ........ Prop. Line .....,f..�......... LEACHING LINE No. of Lines ----.-----•-----_-_ Length f each line... ..��.... Total Length __�1 _. ........... /.:__. Type Filter Material._ ,D. Box ..... ..__'°' ....Depth Filter Material .....�.�...........................::.. Distance to nearest: Well -.7�----•........ -- Foundation ..... •• _,.,.....�_... � . Depth - --------'-- r amu ------ Property Line / .............. SEEPAGE PIT � -- ----• Diameter x ----- Number __....................------ Rock. Filled Yea 21 No C] _. Water Table,.De tit ..�?-e r ' ^- - Rock Size -- Distance to nearest: Well- -"...Foundation ....... Prop.'.Line ��?. ' ---....... REPAIR/ADDITION{Prev. Sanitation Permit# ................. ------------------ -- ---;Date __._._.•_.._...._..._....-----•--•} Septic Tank (Specify Requirements) .................. . ........... -•-••----- ....---••-•........... . ....•---................._...f-•----. .............. Disposal Field {Specify Requirements) .-....__._ I s :.. ------------------ ------------> ........................ •--------••-•----•----- (Draw existing and required addition on reverse side) - , F 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 Son Joaquin Local Health,District. Homeowner or 11cen. f 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 biect to o an's Compens ion la of California." i r Signed `.. . ------ncraetr - -- ------- --•-- By Title .... ---------• - .................... t (if other than ownerl FOR DIEPARTMfNT USE ONLY } APPLICATION ACCEPTED BY ----- -------- •- BUILDING PERMIT ISSUED ........ . ........•........- _ ---------------------•-------------- DATE ...........-_. ,. ............ ....... ADDITIONAL COMMENTS ------------------------------• _ ......--- ----- 41 - ............� - . Y: ......... .......:. ----.- x..-".``7/-.-..._ ..---....--......Date .. ..._`��......� ..-Z ' EH 13 2)t 1-6 Final inspection bSAN .JOAQUIN L AL HEALTH DISTRICT 8/711 3M