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FOR OFFICE USE: APPLICATION FOR SANITAT.'ON PERMIT i Permit No. ,7t3__.X 1_. ..._... --- :......... . ..... . [Complete in Triplicate) -.... ._. .... 7-3 i ..--. ........... This Permit Expires l Year From Date issued Dated 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. 544 and existing Rules and Regulations: JOB ADDRESS/LOCATION .� �r?�i .,�c�..,� rC---IeZ, .......:. ......CENSUS TRACT Owner's Nome .-,/i'/../X f"�� .t✓ ...-----•----I——........... ................. .. Phone ................ ... Address ....` J��i�lf�f..�......... -------------------------------------- City Contractor's Name . r .License # ls Phone Installation will serve: Residence ❑Apartment House❑ Commercial railer C Motel ❑Other .... .................. /.. Number of living units:... ...... Number of bedrooms/-.;?—.--.. Garbage Grinder .1W.... Lot Size .CZ?�e, �- e --- . WaterSupply: Public System and name ...------ --•----------------------------•-----•---------------•-----------------------------------------------Private JR Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay C Peat❑ Sandy Loam ❑ Clay Loam,® Hardpan ❑ Adobe❑ Fill Material If yes,type ..................... ...... (Plot pion, showing size of lot, location ofsystem 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 ] Size------------------------------------------------ Liquid Depth ..................... Capacity .................... Type ----------- -------- Material---------_---_---- No. Compartments ........-- Distance to nearest: Well ....................................Foundation ...................... Prop. Line .........--...........a/ LEACHING LINE [ ] No. of Lines ---------------- ------ Length of each line............................ Total Length ............................_r 'D' Box ...... Type ...........Filter Material ..... ....Depth Filter Material ............................................ Distance to nearest: Well ........................ Foundation ........................ Property Line ........................0 SEEPAGE PIT { ) Depth ............-------- Diameter ................ Number ---..--------.-- ........... Rock Filled Yes ❑ No 0� Water Table Depth ................................................Rock Size ............... •-- Distance to nearest: Well.........................................Foundation .................... Prop. Line ............... REPAIR/ADDITION(Prev. Sanitation Permit t# ..........<................................. Date ............................ . ....} Septic Tank (Specify Requirements)A _40---.• 1 /.d _1 L7i�i1F._.. ldr ._..� j /✓...,1 ......... Disposal Field (Specify Requirements) ----------------------------------------------------------------------------- ------------------------ ---------- ....................---------------------------------------------------------------------------------------------------------------------............------------- . _------------------------------------------------------------------------------•-- ..............------------------•-•-...----------------------------------------- ---------•-----•---------- (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. Hame 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 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ------------------------- - Owner By ....... ......................r �s • Title . `'/. /`.'........ -------- (If oth an owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . ---•----• DATEhP BUILDING PERMIT ISSUED ..........................................•....... ...................... •••....----•--•.....•----DATE --------..............---........... .... ADDITIONAL COMMENTS ....................................... - ------..................................................:.......---- -•--......... --------------------------------------- -- ---- -- ---------------- . --- ------------------------------------ ------------------ Finai Inspection b Date . ...:...` --- P Y: •...... ............... .... .......•-•---... ------• ---- -•--..---------------......----•-•. SAN JOAQUI . LOCAL HEALTH DISTRICT c u 13 24 , 7 /in I v