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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT y. lCottrplete In Triplicate) Permit No. ------------------------- This Permit Expiras 1 Yedir From Date.lssited Date Issued ... .._.. ....... Application is hereby made to the San Joaquin Local Health District for a permit to construd and install the work herein described. This applicatian-ls mrode'in`compliance-with-County-Ordinonce--No:�549 and existing Rules and Regulationst a JOB ADDRESS/LOCATION r........... ...... �!..�'f%5�..;, �. ....-;CENSUS TRACT ......................... Owner's Name ......i.......... Mrs Martinez .......Phone Address -....... . .......................... ............. Y+1[1...._��.�d.... .:City ....... .......---...............-................................. Contractor's Name ..i:....... ...._ zer....SeX.................License # 2.7.153.9......... Phone 465-2-6.7.6......... Installation will serve: Residence[I Apartment House fl Commercial urailer Court Q Motel ❑Other Number f living units... Number of bedrooms Garbage Grinderye�...... Lot Size .. �-.b .-X20.................. o g - Water Supply: Public System and name ----------------•-.. -••-----•---.......................-- •._...�..-.:.. v d• ..........................:...Private L] Character of soil to a,depth of 3 feet: Sand❑. Silt Q Clay Q Peat❑ _Sandy Loam Q Clay Loam ❑ Hardpan❑ Adobe 0 Fill Material -__n o:. I# trip es a............... ............ ,Y (Plot .pian, 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 pu611c sewer is available within 200 feet,) PACKAGE TREATMENT I } SEPTIC TANK f ] �' quid Depth . S€ze... - :::........ - Li ......................... Capacity ----------•-----•--• TYPe.-----.-- -�--- Material-........._'•----- --- No. Compartments 0. f .distance to nearest: Wel{ .............................foundation ................•---.. Prop. Line . ...... ...- LEACHING LINE ] No `Eines ----------------------` line........... __..___.- 'Length of each lin : ---• r , . �,.� r ... Total Length .......................... .� 'DQi1ox '°. .�_•-?Type Fitter Material ....................Depth Filter Material Dista c oto nearest: Well ......--•--- .......................•----.............. ---> Foundation .......--••. _...._ ` .. . __--. Property Line SEEPAGE PIT f ) Depth .....F Diameter Number - •'r - ---- -------•---••--- ----...__.._ •-•----- � Rock filled Yea ❑ No C1� --Water Table Depth -------------------• ------------• - •...Rock3ize .......... ................ v+ i { Distance to nearest:.Weil -----_...I................:...........Foundation ---------- ........ Prop. Line ................. � REPAIR/ADDITION(Prev. Sanitation Pe mit# ----------- ......_----------.---- Date ..-,------ ... -----.---•..j Septic Tank {Specify Requirements) ............. Add 1-!l_'b� 6Sby 1.0 ' sump to existing system Disposal Field (Specify Requirements) z-................................. •----•-••-- -----------• ----•-• ------- .................................... :.. .1 ------------- •--- ... ...................-.._.:.................... .... .. ....".................... (Draw-existing and required-addition on reverse,sidej,,,. ` 1 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 Heo11h:DIstrlet. Hama owner or licen- sed agents signature certifies the following: . a "I certify that in the performance of the work for which this permit is'issued, I shalt not employ any person in such manner as to become subject to Workman's.Compensation laws of California." Signed1.7 ---------------------• --14 - --•-- ---- Owner ---- By -----------------To-e---Why--fie--------------•--------.: Title Contra--.__--_ctor (If other than owner) + 'DE A ENT SE ONLY ff'' APPLICATION ACCEPTED BY .. -t--- -_ !�__.Yf__- DATI= ...�_�.�_�.`- ---------------- BUILDING PERMIT ISSUED �'4 AD T10NAL COMMENTfi ;-; DAT ................ .. ------�4 1 ,� .... ... (rt J: !_ ._..... al.. Fina€ inspection by: .. Date - �..... .— Eli 13 24 1-•6(3 N JOAQUIN LOCAL EALTH DISTRICT / /� ' �t�e