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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT " Permit No. 7� )Complete In Triplicate) )C -- This Permit Expires 1 Year From fate Issued Date (sued .1�._.. . .... Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work heroin described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ...p7_ .7...W... ........NOW. ..01 ..................................CENSUS TRACT .......................... Owner's Name...a..M/ns,/....... i ---F-••----•...............I...............I......................Phone .................................-.. Address ..........V_&'� ................................................ .......................cit,, ..............-•............... Contractor's Name ......100- PQ._- 4�7L7,e; 4.1'.................•-•..........License#27Z-O '.6Phone -----•---------•- ........: Installation will serve: Residence go Apartment House fl Commercial❑Trailer Court ❑ Motel [I Other---_----------------- ..................... j� F � Number of living units:............ Number of bedrooms ...t'.__Garbage Grinder AA... Lot Size Water Supply: Public System and name ..................................................................,..........................................Private j Character of soil to a depth of 3 feet: Sand E] Silt[] Cloy ❑ Peat❑ Sandy Loam ❑ Clay Loam o Hardpan ❑ AdobeP Fill Material ............ If yes,type............... ............ (Plot.plan, showing size of lot, location of system In relation tor wells, buildings, etc. must be plated on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit .permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK Size....................................... Liquid Depth .......................,.-� Capacity --........... ------ Type .................... Material...................... No. Compartments ......................�' 1 Distance.to nearest: Well _.----•.................•-----._---.Foundation ...................... Prop. Line ....................5 LEACHING LINE [ No. of Lines ------------------------ Length of each line...................___..... Total Length ............................ 'D' Box ............ Type Filter Material ____________________Depth Filter Material ..----------------__._.__.____ -- --- Distance to nearest: Well ........................ Foundation -------- .......... Property Line .................s.... SEEPAGE PIT [ j Depth -------------------- Diameter Number ----------_ ............... Rock Filled Yes ❑ Na CV Water Table Depth .Rock Size Distance to nearest: Well ........................................Foundation .........----.------ Prop. Line ....-- .............. REPAIR/ADDITION(#'rev. Sanitation Permit# -------------------------------------------- Date --------- .._.............I Septic Tank (Specify Requirements) ---................... ............................................ ..............-.........................._,.......... _................. .Disposal CField {Specify Requirements[ ..-A�?. -- + ,�t� !r� ,..._. ..................... .. •----. --••-------------------------------- t�`" ,1� ,�-f'!_.� Sim '� - (Draw existing and required addition on re4erse side) 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. Henle 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 Cans ensation laws of California." Signed Owner • .......................... -- --......-•----..... Title ,, ' BY ----- -----• � ther than owner) FOR D PARTMENT USE ONLY APPLICATION ACCEPTED By ----- .rLr . ..... ...... ........ --------------- .--------------------------------------------------------- DATE .... ...8 5G 175 ._.._...------- BUILDING PERMIT ISSUED ------------------------- ::. -------DATE --_----- ------------------- ADD€TIONAL COMMENTS , ,..--- -----------------••-••--------------••--------•-------- " � ------------ � ------ -------- --------------------- :.__...__... ....... -- ----- -•- - Final Inspection by: --------------• ...... Date -. ..�1. .� J3 2)t �� • SA JOAWIN. LOCAL HEALTH D#STRICT 8�7l,• 3M