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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT'. ............... :. Permit No. ..7_...... y-SJ-: (Complete in Triplicate) ..................... ...• 1 Date Issued _-_.`.............. ------ This Permit Expires 7 Year From Date 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 ADDRESSAOCATIOW..:.. W_.........................CENSUS TRACT --- �'o Sb X13 ` Owner's Name ....... a e.... !a• -•............:...........:... ...Phonee:3_✓`+ "•-...._.....__._.... .................... Address .."...........SPr'" �-e.........,�.............""--=--.._.. "----•-"----_...._.__. city -----�7 •--. ------ ................... Contractor's Name License # 6 S�6 Phone ._ :•�f T/i"oar '�r..5_a�--- ....__. �............. Installation will serve: Residence ❑ Apartment House Commercial :❑Trailer Court 0 -.a_,_-..-_.. ` 19 Motel (l Other -_ �Gv------ -_---- -�_------ Number of living units_____________ Number of bedrooms __........._Garbage'Grinder .._.__-_.... Lot Size • -----•--- Water Supply: Public System and name •----------------- ----------------- -----'-------------.....-----""-----_.......-----.___..............._..Private in racter of soil to a depth of 3 feet. Sand r] .Silt 0 . Clay ❑ ' Peat❑ 4Sandy Loam ❑ Clay Loam Hardpan Material If yes pes ❑�`Adobe-❑`�Fpl Ma '�. ty �. (Plot plan, showing size of lot, location ofsystem in relation to wells, buildings etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pitpermitted ifpublic sewer is available within 200 feet,) : PACKAGE TREATMENT [ ] SEPTIC TANK-[ ] Size_______`f ..-•-•......................:..... •- Liquid Depth --------- ................ # Compartments ........Capacityryp =-Material ----- J Distance to 'nearest- Well .-_-I...............................Foundation .. .�-. _.. Prop. Line ....._............... . I LEACHING LINE [ ) No. of Lines -"• length of each line-------------------....__�__ Total Length _._.__......_-_______ ...... 'D' Box------------- Type Filter Material ....................Depth Filter terial __-.---..""".-•--------•---.._...•-----_:_.. Foundation .- ---- ••"- Property Line ---------_.............. Distance to nearest: Well ......�..-.-_- i SEEPAGE PIT [ ) Depth; .:................ Diameter; __._"""___..._._ Number ----......_____....1..1 ..._ Rock Filled Yes ❑ No �Q Water' Tables Depth ............. ...............................Rock Size ........ ..........-_-.......... s k i Distarice`.to nearest: Well ...._ _ ............... ....Foundation . . . .............. Prop. Line ...._____._._.. Qa,)DDITION(Prev. Sanitation Permit# . ----------------------•-•-••• .. Date _•__.__........ .....------.._.c To (Specify Requirements) ........ ----- ........................................................ ........ ..._...._....._...._.. Disposal Field (Specify Requirements) FT 7 .................. - - GAL-— C�3 T� h 13.5r si n/....- -------- Disposal ......... �� X ..�.... i L TAY•. f'------------_-- ...........et� . ----•---____._._.......-.------_._....... r (Draw existing and required addition on reverse side) 1 hereby certify that l 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- sod agents signature certifies the fallowing:; l "I certify that in the performance of-the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed �" / !.Tf-a ,ik _ .... SO,( -----..."--""-"""-"-•. Owner By ------._.._. .. • .... .......... ................................. Title - (If other t r) y FOR DEPARTMENT USE ONLY -744 7 APPLICATION ACCEPTED BY . Tt ....... ................... .... DATE .... E ._........ r..... BUILDINGPERMIT ISSUED -----------------"_"""-•---•---••----_ -" "---•------ ...__......._........._.,-_----•- ...DATE ----........._..--_._. "-" ADDITIONAL COMMENTS I + ._.......---•.......................................:....:... ... ........................ ................... ---"----"__________________"-"-------•---•--""-•----------------."."" ----• ....... Final Inspection by: ..... :. .......................:......................•...............:.._.........Date . . _-..Z�"_......_ SAN JOAQUIN LOCAL HEALTH DISTRICT t c u 3-3 24 1_'AD Ds SAA 7 72 3 M