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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT { Permit No. 7X..-..°Z 37 (Complete in Triplicate) This Permit Expires I Year from Date Issued Date Issued ..T. _- 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 Co un Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/ CATIO [�1rrr- ------ _,. `'`. "� J..........CENSUS TRACT .. _ I......... ' Owner's Name .............. ....... .. ne -A ? Address ... . - ... -------.._. City .......... Contractor's Name ....... :. -------------- - --•---------------•----•--------.License # ....... Phone __...__ ,V .... ............ Installation will serve: -Residence ❑Apartment House-ED Commercial ❑Trailer Court C] i Motel []Other ..._ ... Low ..... Number of living units:_... :...... Number of bedrooms __._ rbage Grinder . Lot Size ............................................ Water Supply: Public System and name ..................... --------__----------,.....................................Private ❑ Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loom ! t . Hardpan _[ ,� Fill Matedol ----=:_ -:.._If yes,. I (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) C NEW INSTALLATION: ' (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT SEPTIC TANK [k SizeZ'a?... ...._.._... Liquid Depth ....................... � � Capacity--- -------- ---- Type --------------------- Material40W'� No. Compartments i s Distance :to nearest: Well -------------------------------Foundation ...................... Prop. Line ...... ........... LEACHING LINE No. of Linesg . .... Total Length ... .. ,[J' -- Len th of each line ;. _. f�.. . F D' Box .y..� . . Type Filter Material __A,04-vt,.:_Depth Filter Material -..�..:..............:..._=............. f Distance to nearest: WeII, 6-0- ------ Foundation GF.. _-..:- Property Line.... ............ SEEPAGE PIT [ ] Depth ._ . .. Diameter ........:...---- Number .-.- Rock Filled Yes ❑'r No Cj. Water Table Depth _...............................................Rock Size .............._............... i Distance to nearest: Well ........................................Foundation _.-..... ... ....... Prop. Line ........ REPAIR/ADDITION(Prev. Sanitation Permit# ----------......----------------------•e:Date N._........... .......... ; Septic Tank (Specify Requirements) --------------------- - •-•-- -----.-...-------•---' -------------•---------...-----......------.....-._....---------- ........... Disposal Field (Specify Requirements) ......................... ------(--------...--------- ------ ...--._....-- . °'............_.... t . ............................................._...._... - - --- ••---- .._... -- ........----......... ......._.:_ - �`--------• - - = —�-�—•(Draw existing and-required addition on reverse side) - -----x�-- �- I hereby certify that i 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 lim- sed agents signature certifies the following: + ' IIlk . .. "I certify that in the performance of the work for which this permit is issued, (shall not employ any person in such manner as to become subject to Vi A4man's Compensation laws of California." Signed _ :c--' .:�: rc _ _ Owner By ---- --- Title .... .... .. ...- .. ... (if other than owner) a FOR DEPART ENT USE ONLY # APPLICATION ACCEPTED BY . ..... - . ..... --- - e > ... :. DATE '."7. ..........._ BUILDING PERMIT ISSUED - - ._... •---••--•- . ... ............-DATE _...... ADDITIONALCOMMENTS .......... -- •------- -------------------------------------- ------------------_....__....._......----.'.............. ------ -------------------- R_ -------- .. -f ' t 'r .... - �ca- .'. Final Inspectioia by; __: . ._� .a._ ..... :. ---•---Date .... /... : �:.... SAN JOA9VIN;.L0CAL ,HEALTH F DISTRICT , F k 13 24 t.-AA ap,, ,n,t 7 72 3 .+t: