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• FOR OFFICE USE: F!_ FOR OFFICE USE: A, ,tICAYION FOR SANITATION PERMIT ------•----------- --- -- 7 (Complete in Triplicate) Permit No......7.7. -- --------------- - - ---- ------ -------- ---- Date Issued../ f ................ . This Permit Expires 1 Year From Date Issued plication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: ADDRESS/LOCATION >= 7-..� . ..... . :[...... ...- ......`. `=. .L CENSUS TRACT .... .. .......... . .. +rrer s Named L° n:-:{'�--.. ! �'(w --------- --- "---- ...... -"--' -'--' ........ Pone c idress..' ' --..- �cc �1��. _....... .Cit . .... '-» �... Zip ../._... /......_... .. v ptractor's Name....._. �!••i�fh. :� �: 1 .... C... License #-_ C....__z_. ..Phone............ ----- ---- -- I :allation will serve: Residence Apartment House ❑ Cornmercial [2" Trailer Court ❑ Motel ❑ Other.-- -- '-" ------------- ,nber of living units:...._.---------Number of bedrooms............Garbage.Grinder........ ---Lot Size------ .. . ........................... . ..... F L! ater Supply: Public System and name ' '. ....... .. ......... - ---------------4__2---'--' - --.............. ........................._-....__Private ❑ Fracter of soil to a depth of 3 feet: Sand F] Silt E] Clay E] Peat EJ Sandy Loam Clay Loam ❑ Hardpan E] Adobe F-1Fill Material.- _- If yes,type.lot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) N INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) - i J// / ( / �/ c CKAGE TREATMENT [ } SEPTIC TANK [ Sized/.�_ L.... -L....f'.._':..._ ...Liquid Depth - . .------._ Capacity.l�E C:_ _Type. ` Li,�'� Material__. �__�`�........_.No. Compartments......- �=--'---....._.- "U� r Distance to nearest: Well....... �--5_��"-r--'----�--------Foundat'son.--._..E._C --'---....Prop. Line......-.� ..................� :ACHING LINE [ l No. of Lines__- -------- Length of each line...............:..............Total Length _....--. ................... 'D' Box..-- --.-Type Filter Material....................Depth Filter Material---.---------------.-------.:...... --------"--'---'- ----....� F j Distance to nearest: Well..... ......................Foundation................------- - --Property Line.. .__ - .........-- - :EPAGE PIT [ Depth .. ." Diameter......./' Number---------- .----------- Rock Filled Yes E!J�No L0 Water Table Depth .......... _ Rock Size. ' !•� ------------ r r 1 Distance to nearest: Well--.--.--- ..j�'-----------------------Foundation.........t:P._ Prop. Line.....: ------------------� C,AIR/ADDITION (Prev. Sanitation Permit#----- -------- ----- ----------_------ '-"--.. -.Date...............------ -- -------_-----------) S F 'tic Tank (Specify Requirements) _.--- --- ----- .. .. ------------------ ---------------'--------.------ ...................... --...--------------- 'isposal Field (Specify Requirements)--- " "-- " ---------------------- ---- ---------------------- ------- -- ------- ------'--......--- ............. --------------------------------- ---------------------------------------------............ .....-- -----'--' 4 --------------I --"--------------------------------- - -------- --------------------------..-....------------------------------------- -------------- ----- - - ------.....0 i (Draw existing and required addition on reverse side) rereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County irdinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed agents {i nature 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 become subject to Workman's Compensation laws of California." ned.-. ..... .. -- ------------ ----------------- >...- --...----Owner Title_. :...... --'--'-' --------' -------'--'- ---- - -- -'--- � �.c.�L_ .�C��L ". 11f other than owner) FOR DEPARTMENT USE ONLY 'PLICATION ACCEPTED BY------ _. ..DATE _ -... ../ AVISION OF LAND NUMBER ' ---•'- " - ----- " -.....___ :.. -' - ----- ' ------ ---- ----------- FDITIONAL COMMENTS.. DATE. k - ..-..-. / ..........................---------------------------------------.-.-..__.._....---.......... - — - - ._...-..-- /�J9._- � ... . .......................... .............................................. ��-......-../a._....... ............... _ r .... ..... .. ' a- .---- F,", inspection by:. ---- /�.f- Lam- z'C,ls..:L✓ Date �..u.-. 1. -' H r3 24 SAN JOAQUIN LOCAL H LTH DISTRICT F&S.2+'677,REV. 2ne 3M.