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,FOR'OFFICE USE: APPLICATION FOR SANITATION PERMIT ....................................... ��.2-.. T �.. :...... a •, '�� (Complete in Triplicate) Permit No:.7.3..... y s Date Issued -�3 . This Permit Expires 1 Year From Data 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: CENSUS TRACT ............. ..,........ JOB ADDRESS/LOCATION .__ ._;.......:. . ........ Owner's Name....._.... .1 .....� .yi Yf.......................................... P ... hone ............................. .---- Address....... ............� .-....Z.........1 ............ ................... city .............. ................................................... 2S�f -3�f Contractor's Name ....... .�-c_v....,• -- �� •-------------------------License # .... _..._... Phone .......... ......... _.e Installation will serve: Residence' 0q Apartment House Commercial ❑Trailer Court ❑ Motel p Other ............................................ _ Number of living units:..__...(.... Number of�bedrooms __._-..Garbage Grinder ............ tot Size ............... Water Supply: Public System and name :`................... .......__._....................... >.......... ,................................ --......'. Private ❑ Character of soil to a depth of 3 feet Sand B . Silt Q� Clay" ❑ ,,, - Peat ❑ Sandy Loam ❑ Cloy Loam ❑ Hardpan ❑ Adobe Fill Material ............ if yes, type ................. .....:..... (Piot plan, showing size of lotr location .of. system in relation to,wells, buildings, etc, must be placed on reverse_ side.) < < NEW INSTALLATION: (No septic tank or seepage pit permitted ii:',pubtic sewer is available within 200 feet,] PACKAGE TREATMENT (] SEPTIC TANK-[ ]' Size_ ....... ............................ Liquid Depth ............ ......... Capacity ............. ...... Type .............. Material...................... No. Compartments ..._........:...... - Distance to nearest: Well .........................:.........Foundation ..............------- Prop. Line ..................... LEACHING LINE (] No, of Lines ........................ Length of.each line ......................... ..... Total Length .................... 'D• Box ....... Type Filter Material �_.._.....: ...... Depth Filter Material ...... ...... :................................ Distance to nearest: Well I .......... .... Foundation ................ Property Line ........................ SEEPAGE PIT [ 1 Depth .................._. Diameter Number .................... ........::.....: ..------ Rock Filled Yes ❑ No Q Water Table Depth -• ........................ 1 ............... Rock,Size ---...._...........- �------ Distance to nearest: Well ........................................Foundation........... .......... Prop. Line. ..................... REPAIR/ADDITION (Prey. Sanitation Permit # ......................... ..................... Date -----•`-............. __._..----• -I Septic Tank (Specify Requirements) ' Disposal Field {Specify Requirements! .._.....---- � .... � y ----- 1 It -z f --'K-_------------!......:.----------------------------------- - - ._.. f ,Q t �.................................... ......................... . •.f �. ....................... ...........................................................:...:............_...... ....._._...._......._......._..........._._.__------'-' - (Draw existing and required addition/on reverse side) I hereby certify that I have prepared this application and that the/work will be done in accordance with Sacs Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin local Health, District. Home owner or licen- sed agents iignature certifies the following: f "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',Californiu." Signed............................ ..... ..........Owner BY... P = .... Y1tle...........::.. .. . (if othe t n owner)_ FOR DEPARTM6W =USE ONLY APPLICATION ACCEPTED BY ......_1.... ..... �rc�X DATE ..... ?.' L.�.?".. ��-.... BUILDINGPERMIT 155UE0 ............:.:..............---.......:............................. 4 .............. DATE ...._......_............................ ADDITIONAL COMMENTS .... ......._ _ ..�K _ .................................................................................................................. _....... =n. ., ......... .......... ... _ `................. .............. . ._ ^ .. � . . --•----- .._ .. Final inspection by: _. !" .........................Dat ... ._> ... ...........-��,,... .........._ .SAN.JOAQUIN LCICAL HEALTH DISTRICT 13 24 ,.,Aa os„ A)_, 7172 3 M