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TC9AT USE: 1s4111CATION FOR SANITATION PERM (Complete in Triplicate) Permit No. _71=1.1-0 .----^---•..................._.............------. ---------•----••--••--•-----•-•--- ............... This Permit Expires 1 Year From Date issued Dote Issued 4-7—L-.7 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 ADDRESSAOCATIION -.� G !fo�CENSUS TRACT _... 2- J> �� Owner's Name r �t_f� �i.......................'• -----........... �h - - phone Address ---------------_....-------kraffr!_t?i....................... - _.._....City - 6�...p.� AA -------•-----••--•..._.---•--......_...-.•.----• Contractor's Namei: / -1 !Tls2Q.! -- _-_---__...----.license # _?�'7V_77,1----- Phone Installation will serve. Residence ❑Apartment Houseo Coomniereial OTraileSCourt 0 Motel 0J Other Style--./7o6% �p�� Number of living units:...... .... Number of bedroo s .._._.Garbage Grinder .... R.. Lot Size ._.._ ............. Water Supply: Public System and name __...._.. ----------------- •......_.Private - - -- - - Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy loam❑ Clay loam ❑ Hardpan ❑ Adobe D< Fill'Material ............ If yes,type (Plot plan, showing size of lot, location of system,inrelation to wells, buildings, etc must be planed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is oval able within 200 feet,) PACKAGE TREATMENT [ ] SEPTICTANK( ] Size...74;99P- _5X. d.Vnf. Liquid Depth Capacity AT—O •"tf-- TYPa l� Material._�e No. Compartments �. Y d Distance to nearest: Well '.._!9. —Pd'--r•-Foundation tr. Prop, line LEACHING LINE ( ] No, of lines ___.._...._ Length of each line_.._._.-Fa l..._ Total Length ...... �:. = = // 'D' Box .___�_- Type Filter Material�7l6_. Depth Filter Material .......�y d p«" �5 lv Distance to nearest: Well SOr. Foundati n M '�/u _- pro Line SEEPAGE PIT [ J Depth Diameter ................ Number Y .._- Rock Filled Yes ❑ No r j, Water Table Depth ------------. ___R«k Size ..._.........._.____...__ _. Distance to nearest: Well ..........._,_-........._......._...Foundation Prop. Line ..._....-.-._....... REPAIR/ADDITION(Prev. Sanitation Permit# ----_.._----------------------_-------- pate ----------•-_---••----------) v Septic Tank (Specify Requirements) ............................. ......... _... _---._....... Disposal Field (Specify Requirements) /V ._.._..---^--••-•--� -• -'---- .lJ.ofd---- .�P�stt.?:Ci ......................................................................................_ .. --•-•-----._......_..-----................------------------------------------------- `r=G Pmt' - l '�1 (Draw existing and req iced addition on4verse side) *..... ts - � 1 hereby certify that 1 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, 1 shall not employ any person in such manner _ as to besu come tect to orkma ensation laws of California." Signed _ --------------------...__.-------- Owner ey -- er than owner) ............-.........................-._ Title .._.�1 - FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .---..____ q------- ------•----- ---- DATE .----/�...�/.... -._------- BUILDING PERMIT ISSUED .--------- -...._.. - ----------DATE .-----•-•-------------- ------- ADDITIONAL COMMENTS .-...-.---•-_ ..................................._.._.___............................................................... -------_.--------------------4:............................. _..._....................................................._................-................-•--------------................-......................-............._........................... ..... _. ----•.-., -- J-/•- .. -- .-•----_.. .: ..-----... - ----•---------•--...-----•---...__.._.._._--•-----•-•--- � -----------•---..Final Inspection bYDa SAN JOAQUIN LOCAL HEALTH DISTRICT