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FOR OFFICE USE: �. APPLICATION FOR SANITATION PERMIT 'p (Complete in Triplicate) Permit No. .._7Sf..��`1�� .............................................. This Permit Expires 1 Year From Onto Issued 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: f� JOB ADDRESS/LOCAnTION _..E .V .. _t. AI �_ ..........................CENSUS TRACT :.._....._....._.:. ... Owner's Name .......Y�T.I` :.: .�G.C� - -. _ .1 Phone Address ��t Z ..... - ' . City . r To.xt.....-.. ........07...-�......-- Contractor's Name ..D r: -5'--..-..�r-,,-C..........License # ------------- --- - Phone = ._. ./ Installation will serve: Residence ❑ Apartment House 0 Commercial [:]Trailer Court ❑ ; Motel.tOther ... ----------- ------- Number of living units:.. Number of bedrooms ----- Gar a Grinder ....__.:.. _.Let Size �v..... ....:................ Water Supply: Public System and name ................E ..._._..___ -.-... ►. pC1 ... ............•----••-•----Private ❑ N Character of soil to a depth of 3 feet: Sand❑r Silt❑_ Clay Peat❑ Sandy Loam ❑i .Clay loam Hardpan ❑ Adobe ❑ Fill Material --- If-.... If yes, type f------------------------- (Plot plan, showing size of lot, location of system in'relation 'to wells, buildings, etc. must be placed on reverse side.) t P � r. ; NEW INSTALLATION (No septic tank or seepage pit permitted i# pal' sewer is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANKe...� .............. ..Z.I--. ....._ Liquid Depth Z'! .. QQ Capacity QO ...... Typ Mate►ial. �..... No. Compartments __-- -- - tl o N Distance to to nearest: Well Foundation .. � _.. Prop. Line ..._ ---_-... LEACHING LINE 4 No. of Lines .,r Length . f each line...,"6..-fl.''.. . Total Length _.._._ -.f.... 'D' Box ...... Type Filter Materia -. - .��.-Depth Filter Material ....I..�_��_-------------------....._. q Distance to nearest: Wel! _ . . . Foundation ....I. _------ Property line .._.. SEEPAGE PIT Depth Diameters - ._ ..... Number ........... ...:......:.. Rock Filled Yes)< No ❑ Water Table Depth .....17 Q-•'". •----.. Rock Size .��'`z�y _..3A, ------------- -- . .-- - ---- - - ",�'+{.--- ...:.._ Prop. Line :..... ..... ......... � i€ Distance to nearest: Wel! _....,_._._ Foundation .. REPAIR/ADDITION(Prev. Sanitation Permit# ........ ...... -.--- -- Date ....._._.......... .......__..:_.) -I Septic Tank (Specify Requirements) ... .................... .......... ..... ......... .......I............------ .....................----........ + Disposal Field (Specify Requirements) ------------------- ........ ,--- ............:............_ .....----•---.--....... ._. .. .... .................. ............... ...........- ---------I........ ....... ---.---. ------- (Draw existin and r quired 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 County Ordinances, State Laws, and Rules and Regulations of the San 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 sub'ect to Workman's Compensa 'on laws of California." Signed .:Dvw. -�i. '. "- By .. . . ...--- ............... '... Jitie € (!f other than owner) FOR DEM" IM IT SE ONLY APPLICATION ACCEPTED BY . . ---•_.-. _.. .__ . DATE . .. :.. �` _..._.._. BUILDING PERMIT ISSUED ............. _... DATE ._._...---... ........ ....... ADDITIONAL COMMENTS -- .--..------------------- -------•----•- -----------------------------......................... ;': ------------------- .......... ---. -------- ..................... Final Inspection by: -- ------------------------------------------------ ............Date .._....,-.......... ........... SAN'.JOAQUIN LOCAL HEALTH._DISTRICT a F 14 J.3 24 1-,A.Q D__ a►u '7 P713 z u