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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----------------- _..... ........ Permit No. .. 7-3_`...�� (Complete in Triplicate) ................................................... ..:.. Date Issued ........................................................ This Permit Expires I Year From Date 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: JOB ADDRESS/LOCATI ..5 _.._.___L _r....� crKP_._../�Gf.-'-....._CENSUS TRACT .......................•.. Owner's Name ......_.. _.c _..._..-_,G�l . �. ............................ Phone '.2 'o -- Address . ............ -•--. City , ...................................... Contractor's Name License #o29_X/ 7__ Phone �jl •� .Q'..�.. Installation will serve: Residence['Apartment House❑ Commercial ❑Troller Court 0 Motel ❑Other ----•--- ................................... Number of living units:___ ___ Number of be rooms ..... __Garbage Gri der �-� Lot Size ...., ... Water Supply: Public System and name ------- - -- - - -------- - -.....�.�-��_..:._-._..-•--------------------------------------Private Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ V ' Hardpan ❑ Adobe Fill Material ............ If yes,type -------------------•--------- 1 (Plot plan, showing 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 public sewer is available within 200 feet,) PACKAGE TREATMENT [ I SEPTIC TAMC Q ] Z'x(S'?_(7; ixe--__......_- Liquid Depth .......................... Capacity .................... Type .................... Material---------------------- No. Compartments ......... Distance to nearest: Well .....Foundation . Prop. Line } LEACHING LINE V No. of Lines ......../----------- Length of each line-----/a_4�_".._.__ Total Length _Zq.Q_-_.............. � _.De th Filter Material .__.�.�................................ 'D' Box �--- Type Filter Material .� p Distance to nearest: Well _4V__ ___________ Foundation ... I l l F iY�r'r Depth /T�............... Diameter �ll._�!lI3__ Number ......../................ Rock Filled Yes Ck No i❑, p _____________Rock Size _. .� •�/�'r � Water Table Depth ..---•}�-(�----- -------------- • - --•-••--•--•---- i Distance to nearest: Well ___ ___•....................Foundation ..1 ......... Prop. Line .... REPAICADDITION rev. Sanitation Permit # Date 3 --_--•----- ---•----••---•---....----• -.._....--• .................... .) . ._.._.._...Septic aecify Requirements) ......__...._.. • ........_............. •••••----- r Disposal Field (Specify Requirements) •------------------------------------------••- -------------------------------------------------- 1 (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 San Joaquin i County Ordinances, State Laws, and Rules and Regulations of the Son 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, i shall not employ any person in such manner as to become Iec Workman's Comp ati4n I ws of California," Signed ..... ..--•-•-------- BY -------......................................................_..........................--•-----•-- .. Title ---- 6 .._. _.. ..----�------------ -----•------__. (If other than owner) ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ...... _- _.,............ ....... .. . .-- :_._______._...--------_•_..._, DATE ... �.z.._7 ...... ._.. BUILDING PERMIT ISSUED ..__.--.--•-------------•••---••-..._ ............. --_....._._•__DATE ...... ------ __...__..: ........... �.. ADDITIONAL COMMENTS .................... ........................... _...----•...................................•---------.____..........:......---••--------------------•-••-----------------------------•--------•--------------•--•-•-•-•-•.....-•••-•....•-••--- -----• ................................. ._ .. ... . Final Inspection by: .........--••......... -•------••. ••...................Date 1.�. � ................... SAN JOAQUIN LOCAL. HEALTH DISTRICT e „ I ..