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r1J- K QfFICE USE- ....... APPLICATION SE: — _ ~- . -. _.. '= .,• APPLICATION{Compleh in TriICTriplicate) SANITATIficahON PERMITR" Permit No. 7 7` ............... ...... . ..----•••. ....------. This Permit Expires 1 Year from Date Issued Date issued ............... 7j Application Whereby made to the San Joaquin local Health District for a permit to conttreict and Install the work herein described. This application is made in compliance with County Ordinance No. 49 and existing Rules and Regulations: JOB ADDRESS/LOCATION 7 12-: ...... ..,-.............•--..�.�'::?�."-� > ............,.CENSUS TRACT Owner's Name r�? _ (` eI�.. i .......................... �.__._..k . .�, ......... Address ......................................Phone .... :-� i3.�--. .... - -.- �r� �. 1� Contractor's Name ---..-l - f.?. ►� �.. ;[1 i� f......._ License .. .7 .. Phone-Y92-2-13 ... `1 . Installation will serve: Residence fKApartment House❑ Commercial❑Trailer Court Motel ❑Other....----------- Number of living units:--?------ Number of bedrooms -- ----••_--Garbage Grinder I;�.��. .-- lot Size 6-4)•--.quQs. Water Supply; Public System and name ------- ------ --------C3...__...._ .------•--•-•--.._.....- Sand L •._...Private _. Character of soil to a depth of 3 feet: Sand❑ Silt claypeat❑ y Dant. Cia Loam ❑ y ❑ Hardpan' Adobe 0 Fill Material If yes,type f Plot•plan, showing size of lot, location of system In relation to wells, buildings, etc, must be placedon reverse aide.} NEW INSTALLATION: IND Se,&Gs7CRlwepage pit erraitted if public sewer is available within 200 feet,} PACKAGE TREATMENT [ SEPT#C TANK ��[td f 14%e h k f ce-- 'Liquid Depth .......................... Capacity -------------------- Type --- ----------- ---- material.............. ------- No. Compartments Distance to nearest: Well -------------- Foundation ...................... Prop. Line . LEACHING LINE [ ] No. of Lines ----- ------------------ Length of each line.......ri/Q. ........... Total Length ._...Y _-�.......--.. -J 'D' Box .... ----- Type Filter Material 1 I..`'�.� �........Depth Filter Material ..- Distance to nearest: Well �d ....... Foundation ..... Property Line .... ..-f.... ._ . rn SEEPAGE PIT t �+ - _�. T [ J Depth ----- Diameter Diameter . . .-- -.... Number .... .............. Rock Filled Yes No Water Table Depth ..........--9.Q--t---__•----___-- hock Size .. .....RP.tJ .----- 1 Distance to nearest: Well ....... REPAIR/ADDlYION(Prev. Sanitation Permit /.Dd•--------------..__. Foundation ..!.i' _.f...._. Prop. Line ... *. ........ .._ 5Date } --••----- Septic Tank (Specify Requirements) " _.. .......................�. � --Disposal Field ISpecify Requirements) ,1 1 c-eV � --- � - �i raw existing and required addition on reverse side) 1 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 licen- sed agents signature certifies the following: "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 --•--•------------------- ------•--.........•------- Owner By ------•-----••----••---•---•---••------------------------ Title --....... fif other than owner) ....... •--------- ------------- -- R DEW. TMENT LtSE ONLY -. APPLICATION ACCEPTED BY Y- 7" .. .. . . ----_.. DATE /.T..Z ...- ILflING PERMIT ISSUED .---- ----•------------- ....... ------- -••-- TIONAI COMMENTS ...............> -- -- ---------------- ATE _..........-.. ----- _ ----•-- '-� —_ --• Final Ins ection b --- SAN •------•---•--------•-- --......--••- --••--. •------ -- -- -- -......I ......................... El-i 13 24 1-b13 herr. P Y - d... . ._.-• ••- - - ----- -- - ----------.......Date -...5./Z> y ................... .10AQL1IN LOCAL HEALTH DISTRICT /7h 3M