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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ...........................................• - 7S-7(Complete in Triplicate) Permit No. .:... ............... This Permit Expires 1 Year From Date Issued Date Issued . ".7C:... k 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: !OB ADDRESS/LOCATiOI%-�,.--. ... .. _. ................................CENSUS TRACT .....................:...: a Owner's Name .-.. . ..................y.........................:.-:.........Phone .................................... Address .... � �!1EX.r........................ ... •--.. ................... -- ....... City -.................--•--•---------....._.........---•--.... /.` Contractor's Name '�•• 6. = .:. .License #_5P.51�7J Phone .......... :... .. `"TLS -- - ...-----. .-..-- ---= _ ... . Installation will serve: Residence Apartment House Commercial ❑Trailer Court ❑ .� Motel Other ...'::...........................•-•----•--• Number of living units:... -_--.. Number of bedrooms ,5.....Garb 5.__.__Garb -Grinder ...._-...... Lot Size ..�:��... .:��.y._.. Water Supply: Public System,and name •.............•-- --•......-----------....... .....................................................Private ❑ Character of soil to a depth of 3`feet: Sand[] ,Silt p Clay ❑ Peat❑ Sandy Loam fl .Clay, Loam Hardpan Adobe C34111 Material ............ If yes,type _ !`t (Plot plan, showing size of lot, location ofsystem in elation .to wells, buildings, etc. must be placed "on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit pp tied if public,sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK{ ] Size.....�1 ~ ` ' a � ...... liquid Depth A4. .............. x .rt Capacity ........... Material... NoComportments .9. ........Le::. ..... . ' Distance.to .nearest: Well .LCA ... Foundation .d ...•.. Prop. Line . LEACHING LINE [ ] No. of Lines -..._ .............. Length of each line......V.4>~ . Total Length Cr 'D' Box /Z__ Type Filter Material ......Depth Filter Material --- .19'7............................ Distonce to nearest. Well r ......... Foundation .....-R-4?:......_ Property Line ........... .. .. •-` t -- -PfT [_ DepthDiameter ________________t Number ........5 .............. hock Filled Yes 9W No ❑ f Water Table Depth .. ............ ....Rock Size { Distance to nearest: Well z............Foundation ...........VZ521. Prop. Eine .................. , E. REPAIR/ADDITION(Prev. Sanitation Permit# _ .S7y� .. . ..� .�1 _.._ Date .................................:) �- Y Septic Tank (Specify Requirements) ..�` rpt% ' ' = -- 4-. Disposal Field (Specify Requirements) .. _ ;,, �•-C L -------------- .----- .... (Draw exi------=---------------------•-----.............. -••--••-•--•-•......................--....- .................................. sting and required addition on reverse side) f' I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin i 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." r� rr Signed ............................... Owner B Title % (If ether than owner) E FOR DEPARTMENT USE ONLY ` APPLICATION ACCEPTED BY ...... ......................................... DATE .... BUILDING PERMIT ISSUED .. •-• DATE ............................................ -----------------.........-•--- tA. ADDITIONAL COMMENTS ........... ........ ........ ...................... - g'` .................................................. ... . ............ .., .......................................... ----------------------- .. ....... ....4'.:. .. Final Inspection by: -----•- •. .....................................................•.......................Date :... .-/..— ................... SA JOAQUIN LOCAL' HEALTH DISTRICT F . r E. H. 1-3 241-'68 Rev, 5M 7/72 3 M