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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ................... Permit No. __7�.../y 7 (Complete in Triplicate) ...................... This Permit Expires 1 Year From Date Issued Date issued . Application is hereby made to the Son 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: u# JOB ADDRESS/LOCATION .......31AI..,......�� r�.lY. CENSUS TRACT .... ....__.... F Owner's Name ... -/ ......��f. '_.. /� ............... .................................Phone ._..._._. Address ............................... ...............•_-.... City f1 - v.......-.............................. Contractor's Name _ ""'"" ��,..�.:'��.�L�._...� i-.....................license Phone .- .��:�� Instailotion will serve: ResidenceR Apartment House C❑ Commercial❑Trailer Court 0 ';4 -Motel ❑Other --------`------------------•=---•--......-- Number of living units....]....... Number of bedrooms __.-Garbage'Grinder __.- Lot Size .1----- ................. Water Supply: Public System and'nome ..................... I Private ❑ Character of soil to d�depth 3 feet: FSand❑ . Silt D Clay ❑ Peat o Sandy Loam 0 Clay Loam ❑ Hardpan ❑ Adobe tl Fill Material :.......---- if yes,type ........................ (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 oF-seep age pit permitted if public sewer is available within 200 feet,) • is A PACKAGE TREATMENT SEPTIC TANK. - Siae.. ... .,ar' ...... Liquid Depth . ... .........:........ CapacityfC1.....__ 1yp Materi�/-/�No. Compartments �------........ ,� iDistancefo nearest; Well ........ . ....•--•---- _Foundation . IQ ....-•--•-- Prop. Line `............. � LEACHING LINE I4o. of'Lines Length of each --------- Total Len gth .��.--...---- 'D"So`x _V-40... Type Filter Material ( ' .i]epth Filter Material .�� ................. ............ `Distance to nearest: Well r ............... Foundation _/a............... Property Line _4.;7..�01 .............. � * „ SEEPAGE PIT �_ ^� Depth _� '�.......... Diameter ��.��. Nvmber-::.-o�. -_--_._-___- Rock Filled- Yes No • Water Table Depth ___ .. stock Size / I Distance to nearest: Well —r� � ----.-..•...._.._::<:Fou�9dation _1G7.[._.____.... Prop. Line ..� REPAIR/ADDITION(Prev..Sahitot ion,Perm it# ............................................ Date .:.:..........:...................I SepticTank (Specify.Requirements) ................------....................._ ..............................=...--....-.................................-------- --•---- IDisposal Field"ISpecify. Requirements) ......................... ..........................................................--------------------------------------- ......... ;. - ---------------------------------------------------------.--------------------------------------------•----------------------------------------------------------l (Draw existing and required addition on reverse side) I hereby certify that 1 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." Signed .. ... i Owner $Y - ......." r.9 title .._. / •✓C�19le..... . ... --•-IOlt r (If other th owner), } ' - ARTMENT USE ONLY APPLICATION ACCEPTED BY ... DATE ---------- --- BUILDINGPERMIT ISSUED ..--•.... --:--- ... .........................................................DATE _... -------•----------------------------• ADDITIONAL COMM NTS 7y ,•�- -• ..F ...............................................................................................---.. ......------_...._._.._ --•---------------•--------- .-...... ----••• .......-.............................................................. ....----•-•-----•. FinalInspection by: ----- • ---• • h • --•--•----•-------•-•.................................:................ .Date `.. . JOAQUIN -LOCAL HEALTH DISTRICT k ti F. H.13 24 1.'6a R.v. 5M 7172 3-M