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FOR OFFICE USE: APPLICATION -FOR SANITATION PERMIT .. IContplete In Triplicate) Permit No. ..7..—_, ................................. Date Issued .,"o This Permit ExpiresYeei om Dat..lssued 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. 5:49 and existing Rules and Regulations: JOB ADDRESS/LOCATI 011-,�.............:.. .. Owner's Name .. --1.................................... TRACT ^. . ._.:�_. .... . .......... ............ ................... 1 .Address one �4=.. City Contractor's Name 5icense- ... Phone Installation will serve: Residence Apartment House CommercialloTraller Court 0 Motel ❑Other............ living uni ......• •- __ ; Number of . ts:_.._._..._. Number of bedrooms ..__I-Gariiage Grinder ... p r L t Size ..._ 4.. Water Supply: Public Sy stem and name .Private Character of soil to a depth of 3 feet: Sand Silt !Hardpan ] y Q Peat 0 i Sandy Loam 0. Clay Loam El :Hardpan ❑ Adobe Fill Material ........_... If yes)type [ N I ............... ............ r (Plat plan, showing size of tot; location of system in relation twwells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No'septic tank or seepage pit permittedr if public sewer Is available within 200 feet,) f PACKAGE TREATMENT �[.] SEPTIC TANK[ ] Size....................... Liquid Depth ................ii_..... •------- ............ CapacityType `Material................. i No. Compartments Distancie to nearest. Well --- p ...................... Prop. ....................... LEACHING LINE [ ] No. of Lines .._.._.._..-"--_-= _k ength of- each-line.............. .. Total Length ............................ 'D 'Box ............ Type Filter Material -------------i-....Depth ._....... -•Filter Material ........................................... pistance to nearest; Well .. -.�_.�. . Foundation Property Line ... SEEPAGE= PIT [ ) Depth -._...___- • --_-- Diamete t ---------- .-------- Number ------------- ------ Rock Filled Yes C] No 011 Water Table Depth .. L----.Rock Size ................ ... Distance to necesu Well _..._,--_-�•��.J. � �'...,.Fouiidat+ion ... .............. Prop. Line ..- - REPAIR/ADDITION(Prev. Sanitation Permit# ......_. ..: I I-- Date _ ...----•-----.-• ---- ) A .. .. ........... Septic Tank (Specify Requirements) i .......... - Disposal Field (Specify Requirements) f. � � .. ------------•--------•----.. -------------------- --------•-•.- ... ------- -------------------------------___________ (Draw existing and require__________a____dition__......_on._....._..reverse si..._...__.d..e..I)..................................................... .. d d 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 Sae" Joaquin Loeaf Hoalth,District. Heine owner or licen. sed agents signature certifies the-following:—.— --0 ......�p.. "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 subject to Workman's Compensatian Iaws of California." Signed ._..._ y` `'` .4 = Owner B -` Y - C�Ai&------•-----•------------- Title If than owners FOR DEPARTMENT U E ONLY r APPLICATION AC PTED BY ------------------------------"--- f 7-7— r ... r--------- DATE ..fD.r.7.. = ......... BUILDING PERMIT ISSUED --•-- ---••--• ................... ..... . ---------- - -. ADDITIONAL COMMENTS ......... ---- �---------•... -t- ----- -••--------.-._....._..DATE . ......"------•--• ----•------•....__..__. ............................................................. --. • -- _... -• -- ------- -------------••----------------------- .................. ------------......_....-- �1 ---. -- {" .._._.__ ..._. . _ Final Inspection b : __ Eli 13 2tt J-5f3 Rev. -. ...............................Date .. . . �- rz5....--_._... SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M