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i R OPFIC USE: . 3•,(1l APPLICATION FOR SANITATION PERMIT Permit No. J {Complete in Tslpiicatel - ` •.................... ................................... This Permit Expires 1 Year From Date issued Date Issued __.. �l.:.. 5 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 LOCATIO ... ....CENSUS TRACT / c ----�D lel..... e,. ................................. ....- Owner's Name .............. ._ Phone ZST 77 G ,.......... :.. .............. �.... Address ............ C,! • •---- ................. .........City .............._... .... -----------...------------------ ........ Contractor's Name ------ ...............................!.�`----- ......_..... ...........License # .� 3 .3--- Phone ~h�� Installation will serve. ResidenceV Aparhneh t House Q Commercial QTrailer Court Q Motel Q Other .. -•---•------------------ ......... l / Number of living units:_---(_" Number of bedrooms k___,]___._Garbage Grinder ............ tot Size ...l._ .,__._?................. ` ^'l ' . Water Supply: Public System and name -------- ........ ......Private Character of soil to a depth of 3 feet: Sand Q • IVO Clay G] Peat o Sandy Loam� Clay Loam t Hardpan Q Adobe fl Fill Materlai -t..........If yes,type ............... ...........: r (Plot plan, showing size of got, location of system In+ relation to wells, buildings, etc. must be placed on reverse side.[ NEW INSTALLATION: (No septic tank or seepage plt permitted if public sewer is available within 240 feet,) PACKAGE TREATMENT [ SEPTIC TANK 4 X c r - SiSize. - .. ...-•................ Liquid Depth .... ..... . ... Capatityf Type _ !`_`' Material__��"� . No. Compartments -.. ....... Distance to nearest: Well Prop. Line S LEACHING LINE No. of Lines .7 2 g----------- Len th of.edl line.......47 Q...... Total Length ....�.�....Y... S D' Box .._...Type Filter Materiag•'. -. .. ......Depth .FilterMaterial ....___...1 .•��_•................... „.r 1, ? r �- Distance to nearest: Well _._l I1_.......___ Fou dation ----t.A.......... Property Line ................•. Q SEEPAGE PIT --�- Depth •... diameter -___.__.-----_-- Number __.......................... Rock Filled Yes Q No 0 � Water Table Dep* .. Rock Size Distance to nearest: Well _____._...._.,.__-....Foundation .................... Prop. Line ...................... REPAIR/ADDITION IPrev. Sanitation Permit# � Date } 0 f Septic Tank (Specify Requirements) _................. Disposal Field (Specify Requirements) -----------------•-----••-•---•---•--------•----•--•----- ,_.._............. &\ ......................... ......... - ----------- ------------•- •--------- ------------._......................... .. ............... X. 1{ (Draw existing and--------- equired addition on reverse sidey 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 .rork._fcir'whlch.this.permit Is,.issuerd,I_I shall not employ any person In such manner r as to become sublect to Workman's Compensation laws of California." ✓ Signed -- -- ---- --- --•--- Owner ........._ BY ;---- -- - -------- -------------•----_ �it.le (if t er than owner) FOR DEPARTMENT USE ONLY ` APPLICATION ACCEPTED BY ------- �y------- ---- ---co--------------------------------•-----• DATE .-_ ----------------- BUIi:DING PERMIT ISSUED ------------------............-..._-----------------------------........DATE -----•. ----............ ....... ADDITIONAL COMMENTS ------------------------------- ------------------------------ --------------------------•---•- ----------------------------------- ' '------- ----`--•............... .... -----------------------•-••-- ...---.......----- h- r �? Final inspection by .... s�5%�� ...... ............. .........................Date _5` ..�,%,� .-V...................... 11H 13 2h 1-6$ lav;rj`M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M `4 l