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FOR OFFICE USE: • ------. .. ,�.. .r-........ APPLICATION FOR SANITATION PERMIT ------•---• 71 -2Y7 Permit Nd. !Complete in Trlplkate) .. .. This Permit Expires I Year From Date 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: JOB ADDRESS/LOCATION f-" - /�� ,�/ ..........CENSUS TRACT Owner's Name -._._.. . z) �p° .:, /� ¢... .......Phone . w. . Address J .J� !f._.... /!��P�1 .............. City .: �rx _, V" •--.... .................. ----------- Contractor's Name •. 14 i .[,5.5!--- a s:._ 1y e,...........License # ... Phone .10L 0 Installation will serve: Residence Q Apartment House 0 CommerclaII OTra€ler Court 0 Motet Ot er J Number of living units:.---_----- Number of� Garbage Grin er .......... Lot Size ..../. ....c...-............... Water Supply. Public System and name ` a � .....................Private Q Character of soll to a depth of 3 feet: Sand❑ Silt 0Clay 0 Peat❑ Sandy Loam a Clay Loam D Hardpan ❑ Adobe❑ Fill Material ............ If yes,type............... ............ (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 SEPTIC TANK } Sizea. ---.?----- ......... •.-•.-.-._-- Liquid Depth ....- ��.......... Capacity IZO f0..._ Ty pe = L4--- Materia .- .. . No. Compartments ... Distance to nearest: WellAinNe-----................Foundation ._..Z....-p ----------- Prop. Line ........... .... t?t LEACHING LINE No. of Lines -.-:2.. Lengthf ea I€ne.._._ '..._..... Total Lenggth ....._.4�_. ._.. DO 'D' Box __.._ .--- Type Filter MateriaDepthFilter Material .............................. Distance to nearest: Well r. Foundation J... Property Line -. SEEPAGE PIT Depth ._ ._._. Dia eter ZO:--- Number _........lam.............. Rock filLed Yes No ❑ Water Table Depth ...__._ i �'��C P -+V-- --•••••-• -----------------Rock Size _...../..1.......... Distance to nearest: Well -_N.A.R" ...................Foundation _.___ .0.�... Prop. Line ......-,.�....�. REPAIR/ADDITION(Prev. Sanitation Permit# ----------- ---------------------------- Date .................................. Septic Tank (Specify Requirements) ........----------- • --------- ----- ------------......----- Disposal Field (Specify Requirementsl ....................................................:............................. ----•------•. .................................... .. --------------------------------- -------------••----•-- ------ ............ ............................................... • ---------------------- (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 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 shah not employ any person in such manner as to hecame subject to Wrkman's Compensation laws of California." Signed ': _. rV_r'^__�l!_1�r'/-,/ �P ----------------`-- - BY ----------- •-------------------- - _._...--_. Jitle lEf other than own �� ......................... FO EPARTMEN SE ONLY " APPLICATION ACCEPTED BY f DATE ---. •-~-- 7_?._--.......-•-- BUILDING PERMIT ISSUED -- -...__fig._. r........ ......DATE ---------- ................................ - - --- -- - -- ADDITIONAL COMIV� 5 . ------------ ............................... . .. - --- ---- . ------- -------- ----------------------- ............................... - ------ --•-- ---------------................_.................. .......... ------ Final Inspection by: ..- - -------------------------------------------- -------........_--..Date . �.`". - -� EH 13 22a 1-6f3 ffev. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7,1t 3M