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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .................................... .................... Permit No. 7/ (Complete in Tripllceete) Date Issued ..3.'3�:.�� ...................•.................................... . This Perrnit Expires t Year from dente 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 Na. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ..... L�. ..� .... �...��... ....� .....CENSUS TRACT . Owner's Name ... ,.. '�.r. - ..........Phone �i.d . ar �...... ............................ Address .,� 0. .. ...�.e..... C f.�i.e_r,._..e600- �............ ... ... City . .,1� 0............................................. t Contractor's Name ..(22i..i..--.1 7` 'Al......S9W../.T1.4.-7.ZQ.d/_.License # ....... ,... Phare .............................. . Installation will serve: Residence p Apartment House] Commercial OTrailer Court C] Motel®Other__6 ICA/7IF Number of living units:/. 2AW Number of be/�drooms ............Garbage Grinder ............ Lot Size ...............:..:......................:. Water Supply: Public System and name 0 �IJ T�----... W aL............ _.................. .......................Private Character of soil to a depth of 3 feet: Sand E] Silt nGay ,O Peat p Sandy Loam Q Clary Loam Q � Hardpan 0 Adobe[]- Fitt'Material ............. If yes,type:.............. ............ r (Plot plan, showing size of lot, location of system In relation 'to wells, buildings, etc. must be placed on reverse side. V V. NEW INSTALLATIONS (No septic tank or seepage Olt permitted If public sewer is available within 200 feet] PACKAGE TREATMENT SEPTIC TANK Size..,.j� j� ...... Liquid. Depth Capacity �� f..�.- TYPe '� STMatertall.�.+6.&�I.Co. Compartments _... -�...... � VJU Distance. to nearest: Well .................................. .Foundation .............. Prop. Line .................... ..lr+ . .r... Total Length `� .�........m LEACHING LINE { j. No. of Lines til#er Material a! o� �lined Depth .Fitter Material .....-- --- e Box Type #� a ........ ..... Distance to-nearest; Wel{ ,. .Q�..�_...... Foundation ... ....... Property Line SEEPAGEPIT ( ) Depth ..a.9.-•---. Diameter ................ .. _.�,�:. Number l_•-__---. Rock Filled Yes No.o�� Water Table Depth ........ :t...-:-....Rock Size ........... Distance to nearest: Well ............Foundation .,l�a.�. Prop. Litre .........:.: M. REPAIR/ADDITION(Prev. Sanitation Permit# .................•- --•--........-�---- Date .................................. SepticTank {Specify Requirements).-----• •...................... ............................................................................................................. Disposal Field (Specify Requirements} .........:........................................................................•-.............. ......._...... .............. Draw existing d . :.........:. . { nd 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 iwma l4 County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health_1Distritt. Hoene owner or Ilefet- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shelf not employ any person In such manner as to become, ubi to orkman's Compensation laws of California." Signed ... . .. Owner . BY --:...............__.....-------..-------... Title :...... ------ ----•-• ............................................ (If other than owner) FO DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _.4f '. _--- --- -------................•.................... DATE. .... - .. . ............ BUILDING PERMIT ISSUED ........-....... ...... . .. ........-•---....._.._........._..__.._....... :�`.....DATE ........_..._.............__.........:..._. d ADDITIONAL COMMENTS .........:.................... ........ i ..........................•...._...... _.._.I._..---....._ .. .---....._.I... .......... ..................•------...-----.._... Final inspection by: ..___. _..._� - ._Date -. � .... f 1✓7 i 13 21a 1-6{i 11 V V. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M 4