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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT . . . ..... ...... ...... Permit No. ..75----------- (Complete 5s --(Complete in Triplicate) ........ . ........... .. -.?D ------ -------------- - -------------- - ....... This Permit Expires 1 Year From Date Issued Date Issued .................... yApplication 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/LO l N .-.. .. Owner's Nome Phone i Address -/1Z.��C' __. City . ... - ;.... ----•------ Contractor's Name c ......- License #,.25 -. . Phone -.�>-....61.. Installation will serve: Residence ❑ Apartment bu se-❑ Crqwmercial 17rai er Court 0 Motel ❑ Other , Number of living units: . . .,. Number of bedrooms ., .-. -_-Garbage Gunder . Lot Size ----- --•-----•---- Water Supply: Public System and name . . .....__......../ -------••.. . ........ ..... ...Private C1 Character of soil too-a depth of 3 feet: Sand❑ Silt Clay ❑ Peat El Sandy Loam.0 Glay-Loom-9--i-- Hardpan• Adobe Fill Material ... If yes,type ...... . . (Plot plan;owing size of .lot, location of system in relation to wells, buildings, etc.. must be placed] on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if pub]ici sewer,is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK`{ ] Size.... .. ............ . `�..'- 'r,,�Liqu id Depth ..................�1 Capacity Type .. .. . . . ....... Material -.- No. Compartments - .-------••----•--� r r. , r re . A � ation . I.. Prop.�line ....__-_... LEACHING LINE Not of Lines nearest: Well Length of each line Found Total; Length; .. .. ..................... [ � 'D' Boz Type Filter Material ._. .��•D'epth Filter Material .. Distance to nearest: Well .. �-..TFourvddton ;. . ., Property LineSEEPAGE PIT [ } Depth Diameter _,__._._ Number; Rack Filled Yes ❑ No Water Table Depth f ... ... - Rock Size Distance to nearest: Well -. - -- ............. .Foundation . ... ... ;. Prop. Line _._..;---------_- -• REPAIR/ADDITION(Prev. Sanitation .Permit# ---__... _. ... ... Date .......-- ; ---------------I -1 -A ; � l7?� � Septic Tank (Specify,Req u irem�s) ._..........r.,. :.;`.- .,.- __ ._.-. . �- ....,.. ..-- --------------------- Disposal -. . -. . f��yr Disposal Field (Specify <'Requirements) -------- - (Draw existin and required addition on reverse side 1 hereby certify that 1/have prepared this application and that,the work swill be dsrle,in accordance with San Joaquin County Ordinances. State Laws, and Rules and Regulations of the So Joaquin Local Navlih District. Home owner or licen- sed agents signature"certifies the following: 1`1 � "I certify that in the performance of the work for which this permit is issued, I %hill not employ any person in such manner as to become subject to Workman's Compensation laws of California." � I Signed . . .. . .. .. .... .......... ... ......,.- . . -..---- Owner i BY . ;Fide j (I o er t owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTE BY C/T DATE ] -..-.- BUILDING PERMIT ISSUED - DATE . f.......... . . ............. ADDITIONAL COMMENTS .. ._--- -- ........ ............ ........... ..... ... ..... ....... ........... --------- ------- - �_.._.__.� .. _ -... �-•-- ---�.. ............................ . ...... ..,:»---- . . '..- . _.. ..... . ... .... w..- ..... .._ . .......... ....... .. Final Inspection by: ............ .... "�, t " ... �.. - ... .... ,�' - -----� - ... ...--�--....._......__-_...-.Date -------- --- --.'-.71.-.----••---- SAN JOAQUIN LOCAL HEALTH DISTRICT _ . . , ti ni - - - 71793 M