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FOR OFFICE USE: ...........................f�__3�.-- APPltCATf4N FOR SANITATION PERMIT {Complete in Tr4plicai'4f Permit No. 7 ................ This Permit Expires 1 Yearfrons Darts Issued Dote Issued ................... Application is hereby mode to the San Joaquin L described. This application is made in complocal Health Distrlct- Or'j c-�rmit to construct and install the work herein iance with County Ordinance No. 549 and existing Rules and Regulations:. JOB ADDRESS/LOCATION-... �- - g r .....CENSUS TRACT � Owner's Name -.. _ ••• Address ................................................39.- ... Phone _ ._�✓f _ Contractor's Name (� � Cityfc lJ. .. "... t c� 4' ...........License #�-• i kms.- .._.._......_. f.7.. .. Phon31 e nerf? 1 will serve: ResidencebdApartment House{] Commercial{]Traitor Court j Motel❑Other....... ..... ..... . .:.. f Number of living u nits:---�_ f Number of bedrooms ..Z'. --_Garbage Grinder ............ Lot Size . Water Supply: Public and System � �-��•'•••--- Y 'name ....-•--- ............................................... z .............................. ••••-Pr ivcteCharacter of sail to a depth of 3efet: Sand❑ Silt © Peat❑ Sandy Loam 0 Clay Loans 0F I Hardpan[j Adobe Fill Material ....... If yes, type............. (Plot pian, showing size of lot,—location-of--system in relation to wells, buildings, etc, must be placed on revera�3 aTtta.l IYE -INSTALLATION: —. (No septic tank or seepage_pit permifted.ifpubile,sewer is available within 200 feet,) i PACKAGE TREATMENT ( ] SEPTIC TANK y' 1 . l ] Size._...-__--.. ..... Liquid Depth ... Capaciyt f ----- Type ------•------•----_ Material-_.---- •------- - No. Compartments Distance to nearest: Well ------------- - ------------_--_--Foundation .._..._.... LEACHING LINE 1-, �•' ••-•-...--- Prop. Line ......._.... No. of Lines , Length of each 11 no Total Length , .1� D' Box )-1Z3-__ Type Filter IateriaF:" �/ _. Depth Q • ` filter Material L ....... .................... Distance to nearest: Well CQtlFoundation _....J _1......_.... /,i �A SEEPAGE PIT [ c� `'Depths'' r I Property rty dLin Y ..................... �. ,.. Diameter ....t3, NumLSeF �. Rock Filled es ' No Water Table Depth --...........-c� ' ' .-Rock Size ............... to nearest: Well ._._.�_O_..p'..---- Foundation ._..1f.!..... 4:•' REPA_, AIR/ADDITION(Prev. Sanitation!Permit# ....:....__...._-.- Prop. Line ..............�- = -._...----- Date ---•------• I -.._....._.} Septic Tank (Specify._Requirements)................... D,i;.posal Field S ecif i - ( P y equirementsl ..------- I - kr n ._ ---------- ••-------------•---- •------•-•-•----------------------------------------- (Draw existing and.required addition on reverse side) I hereby certify that 1 have preparer!d this application and that the work will be done in accordance with Son.Joaquin County Ordinances, State Laws, and Rales and Regulations of the San Joaquin Local Health.,District. Home owner or licew sed agents signature certifies the following; "I certify that in the performance of the work for which this permit is issued, f shall not employ any person in such manner as to beco �sublect to Workman,s Compensation laws of California." Signed _..-- - ._ a.:�. .--- ............. Owner ••-- (If ath r ------- --- Title --------- -------- ---- than owner) -�._. FOR DEPARTMENT USI: ONLY _ APPLICATION ACCEPTED By _ BUILDING PERMIT ISSUED _,------- .._....---•- -------------------------------------- DATE ... ......._-_---7- -dADDITIONAL COMMENTS -------•---- ' - ---- •-------•................................. ..------ ------------_ _DATE'.._ = . -..-.-.-_-.._..-.-. -�---.-.-.-_- . j .-•- - ----------•------- - ----•-------....._._..------ . -------------- -- -----••-----... ------••--•-. -------•---- --..-....---------------._...---......_.....---..__...---t ------------------ -----------¢ Final Inspection b -- -• ----• • ........................._.... . y: _.. �4z ----..."......................•--•------......._... -----.._ . T1 EH 13 2?� 1-68 ldev. $M ...._.:---Date �:-._.:_..` - ---:::::::::::• 8 SAN JOAQUIN LOCAL HEALTH DISTRICT /711 3M