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Date <br />AN JOAQUIN LOCAL HEALTH DISTRICT <br /> <br />8/7h 3M <br />FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br />Permit No. 7 1-'2 2 <br />(Complete In Triplicate) . <br />This Permit Expires 1 Year From Date Issued <br /> Date Issued <br />Application is hereby made to the San Joaquin Local Health District for a permit to constract and install the work herein <br />described. This application Is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br />_ <br />JOB ADDRESS/LOCATION ... . E • 14111.i. CENSUS TRACT <br />Owner's Name lqbr r.r.v.orv‘ Phone <br />1{1/524FF3 Contractor's Name License # Phone <br />Installation will serve: Residence, Apartment House ID Commercial °Trailer Court 0 ?47— <br />Motel 0 Other <br />Number of living units- / Number of bedrooms 3 Garbage Grinder NO Lot Size <br /> <br /> ..... ........ .............. ivate M <br />Character of soil to a depth of 3 feet: Sand 0 Silt 0 Clay 0 Peat 0 Sandy Clay Learn 0 <br />Hardpan 0 Adobe 0 Fill Mitterial If yes, type <br />(Plot plan, showing size of lot, location of system In relation to wells, ,buildings, etc. must be placed on reverse side.) C <br />( ) SEPTIC TANK I I. - - Size „/-Q 0 0 44 Liquid Depth -5- 6-4=-, ' <br />Capacity ../ --" 1,44Type /Ye- -rdr. Material.earit i No. Compartments L. 3 I ip, <br />Distance to nearest: Well 3.7 . -- -tt - <br />I <br />Foundation ./..40. .... Prop. Une,01.42...e... <br />No. of Lines 3 Length of each line '.0. Total Length ..-/D. <br />'D' Box . I Type Filter Material /4.. 614/Depth Filter Material ./g7 , , <br />! Distance to nearest: Well .-Z7.0 <br />No 0 <br />Address A City <br />Water Supply: Public System and name , <br />NEW INSTALLATION: <br />PACKAGE TREATMENT <br />(NI° septi)c tank or seepage pit permitted if public sewer is available within 200 feet) • . <br />LEACHING LINE ( <br />SEEPAGE PIT <br />Distance to nearest: Well <br />REPAIR/ADDITION (Prey. Sanitation Permit # <br />1 <br />Septic Tank (Specify Requirements) <br />( 1 . <br />Foundation Property Line <br />Depth Diameter Number Rock Filled • Yes 14 <br />Water Table Depth Rock Slit; <br />Foundation Prop. Une <br /> Date <br />Disposal Field (Specify Requirements) <br />- • • • • • • • • • • • - <br />, (Draw existing and required addition Oh reverse side) <br />I hereby certify that I have prepared this application and that the work will be dons in accordance %frith ,San Joaquin <br />County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health. District. Homo owner or licen- <br />sed agents signature certifies the following: . <br />"I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner <br />as to become su=Workman's o pensation laws of California." <br />Signed .... Owner <br />By 144e)YJ jitle <br />(If other than owner) <br />R DEPARTM T USE ONLY <br />APPLICATION ACCEPTED BY • <br />BUILDING PERMIT ISSUED <br />ADDITIONAL COMMENTS <br />DATE 2 7 —7 III' <br />DATE <br />cifyitA.15,4,&"1/ <br />Final Inspection by: <br />ai 13 24 1-6B Rev. 514