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FOR"OFFICE USE: i APPLICATION 'AOR SANITATION PERMIT ------ .......................... Permit No. ..7.�i�-2/�.. (Complete in Triplicate) ............ .............I._.__......... L 1 27 .---..--- This Permit Expires 1 Year From Date Issued Date Issued .3........ 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 k1o. 549 and existing Rules and Regulations: r� q F JOB ADDRESS/LOCATIO .�J7A,..�8: . ..... ............ .. Vis.--....._ ...__ K t.CENSUS TRACT ._..........-- ----•- :. y_-..: ., r .. t Phone'r3/ .. Ca Owner's Name ............. . . .......... ........: ..... ................................•---....,._......�..._..:..---...•--.._....... .................................... Address .-.._...../�"_7!1....__. r. .. ------- ...1`f'z... ity .... ....... C' -�6a 7 Contractor's Name .._...---•--� .. .. .. ....... ......�---5�-�'�-----------------.License #�S�_".a?..`f3_.. Phone !�6�..................... Installation will serve: Residence ❑Apartment House 0 Commercial ❑Trailer Court ❑ �. Motel ❑Other � /� i Number of living units:--- Number of bedrooms ---�_-.Garbage Grinder .._.....___. lot Size .....�t-��_ V................. ' Water Supply: Public System and name ..................... { •---•---••---._................................�_.�._..�_.�......_............Private A Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy loam 0 Clay Loam i W, Hardpan ❑ Adobe Fill Material ...._.....! If yes,type ............________________ \ t V �(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,I �! rPACKAGE TREATMENT ( SEPTIC TANK X Size................ K__8.....__. Liquid Depth ---_.�;Y�........... fJ 7-- Capacity —T)OC.._ .. Type ... .... Material__G.sG...f.G..... No. Compartments .................... Distance to nearest: Well -.......,JrQ._ ............Foundation __._A.0.....-__..__ Prop. Line ..... ............... I LEACHING LINE No, of Lines ........I___--____-- Length of each line-1-07.0............... Total Length �.. `D' Box ..__........ Type Filter Material ._.Depth Filter Materials ................ ..... l � � Distance to nearest: Well ....v.,$..Qr- ._;. Foundation ..____L.O...7... Property Line _�..............? SEEPAGE PIT Depth _...__ ... Diameter ._ . ....---- Number .___......�'. ...--..__-Rock Filled Yes No ❑ r .r/ / Water Table Depth .......•---•..................•-•-•-,.._.....Rock Size .I1. l Distance;,to nearest: Wei..... _______________---��:..1=oundatian�- ... Prop Line __�_�__.___ ............. --�__ Date ....................... REPAIR/ADDITION(Prev. Sanitation Permit+#.. t' 't } Septic Tank (Specify Requirements) ...... ...-.�---------- ---••- --•--• ....... ...........--........................................................ r Disposal Field {specify Requirements) --------- -----------------_------------------------------------------ . ------------------------------------................. ..-----•. ------••• ......-•-...----•--- .._ ---•---------•-------••••-•-----------••...---•-•-----•-•-•-•-•-... .....-•--- ....... (Draw existing xisting and required add ition on reverse side) I hereby certify that I have thi3 aplication and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San tJoaquin Local Health District. Horne owner or iicen. sed agents signature certifies the following: "I certify that in the performance of the work fpr which this permit is issued, Il shall not employ any person in such manner as to become subject to Workrhan`s Compensation law:of California." Signed ........ Owner BY ... .......................... .......................... (If other t owner) �F °P,/DFP MENT USE ONLY J APPLICATION ACCEPTED BY ...... ....... .... ..... .......... -------------------------------------- DATE .......7.:-�z.-/ -- .......... BUILDING PERMIT ISSUED ............ .. . ........ ... { .. DATE ......_....__.........._ - - -------- ------------••-••-•..__.....:... _.�_s.......... ADDITIONAL COMMENTS ......... .. .. •... . ... .......-•-- -•-----•------............._.----....---••-•...._...._.. = ......... ... - ..........:................I.._........... . . .--••--.....__......----....--------------•---..................._.-...•-----------------------....---• .............. I....... Final inspection by: .....Date ... ,l.: l� ................. SAI JOAQUIN LOCAL' HEALTH DISTRICT r .- .. i q 2G 7172 3 M