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p� -4 r# FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicatel Permit No. ...7...:37 . ... This Permit Expires 7 Year From date Issued ate slue -...-...---.-... •F i -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: /6 s-o o /6 3-a o T,'OB„ADDRESS/LOCCATION L4: .., .e.. CENSUS TRACT .......................... 7wner's NomeC7 .....:.. Phone.................................... ....-..... Address ... !!/.17....- �I �r�r�-^r?L..... ..:...................•-............City .... .. --..--..'_-..�f�B= .. on : tractor's Name.....(� a1._.. _.- i - +x/-__-_..License# ....................... Phone .............................. Fs tallation will serve: Residence( portment House F]Commercial❑Traller Court C] Motel❑Other................................... ... Number of living units:.......--.. Number of bedrooms n-.....Garbage Grinder ..- Lot Size ..... ...cuy.� Nater Supply: Public System and name ....................................._........-_..........------- .............._.................._.Private _character of soil to a depth of 3 feet: Sand 0 ilt❑ Clay ❑ Peat❑ Sandy Loam❑ Clay Loam❑ C! 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.) r .., (� / i q Depth PACKAGE TREATMENT SEPTIC TANK g p. P Size-_.-.�_la-___�f--.S................. Liquid De , WEW 11WSTALLATIOtW: of septic tank or seeps a it permitted if public sewer is available within 200 1 Capacity 147+7Q--__._-- Type :w.._. Material-..,Qir ........ No. Compartments _.........._ Distance to nearest: Well ...........e;T.i._.._.i:..._,...Foundation._....Af1__--_.___.Prop.One J`._'___-------- _______ LEACHING LINE ( ' No. of Lines -- Length of each line--.-... r. Total Length �..--- f _-.... th .....rL�% 'D' Sox --- Type Filter Material ._.._err ......Depth FilterMaterial .-:....1Y.'............................ Distance to nea/rest: Well .........jP-......t_. Foundation ... r.......... Property Line FiEEPAGE PIT (1� Depth ..... Diameter Diameter __. N_.._ Number ...:.... ........:....... Rock Filled Yes No ❑ 3 Water Table Depth ............../- --.....--.....................Rock Size..1�._.__�'__-.._--.._., l ell ::..... BOG / Distance to nearest; ... _:_............... Ftendatlon _ -- -irnp Llne tEPAIR/ADDITION(Prev.Sanitation Pe mit .' .: . ': . . . . Da ... ----- Septic - Tank (Specify Requirements) --••...........................................................................................................:........------------------ Disposal Field (Specify Requirements) r ..........................................................................................---- ............................ ....................................__........................... ............................... (Draw existing and required addition on reverse side) hereby certify that I have prepared this application and that the work will be done in accordance with Son:Joaquin :ounty Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District.Home owner or Rcen- r* ed agents signature certifies the following: "I certify that in the performance of the work for which this permit Is Issued,1 shall not employ any person in such manner as to become subject to Workman's'Compensation laws of California." iigned...- ------------------------....... . .......... .. Owner ..._ r iy............................................... JJ- Jitle (If other than owner) G :.. 4PPLICATION ACCEPTED SY---" FOR DEPARTMENT USE OIWLY•..................... DATE-.".5^.x .:.7 ._- _..._--..___. 3UILMNG PERMIT ISSUED .....:....DATE.................... ADDITIONAL COMMENTS..".....--.•.......................................................---.........--..................._.................. .......... -.. '.-•................................ .....---.._.__..-_..-...--•-----._.._..---..._...-.-....-----------------------..-. ------------_--- - I ._ y� . . . ---•-----_-.--. cinal Inspection 6 DS SAN JOAQUIN _LOCAL HEALTH DISTRICT.