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! *40W FOR OFFICE USE: i FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. ......................................... . ....... Dote Issued.. . , r 7� ............ _..- .... - _ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Lozol 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 ADDRESS/LOC 7/ Az 5 � ��:U'..� .. _ _ CENSUS TRACT ........ .. .......... .... 1 Owner's Name .... Phane_ .. .......... ............ ..... Address • ' 71��-! . ��'l CityC.' tc d1�..��....zip.... 1:-.... �. —� y License # �.��Z .�..... .Phone : Contractors Name.. �'-cla-,��..t.�- � �. �•� _. ....... ... . ... ....... Installation will serve: Residence .'apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other. _ .. ..... Number of living units:.._. Num'oer of bedrooms . _y .Garbage Grinder._ .....Lot Size ... .... ...-................. Water Supply: Public System and name . .. . _... ..... _ ....._..._ .-.. ._-._.................................... ...Private 15 Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay❑ Peat❑ Sandy Loam[r]' Clay Loam❑ 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.) NEW INSTALLATION: (No septic tank or scepoge pit permitted if public sever is available within 200 feet,) PACKAGE TREATMENT ( j SEPTIC TANX [ i Size. ... .. . .. .... ................Liquid Depth .. ...... _.... ... ....� Capacity. - .. ... Type ....... ... ....Material .....,Rio. Compartments..... .._........ ............. Distance to nearest: Well . .__._ . _..... .......... .... ..Foundation . ........ -. ._-. .... Prop. Line . ... .. ............... • LEACHING LINE ( ] No. of Line:. - length of each line ._._ __ Total Length .. ._.. .. _...... . . ' .. . ....... 'D' Box ..- . - .Type Filter Material. Depth Filter Material....................-................_...... ............ Distance to nearest:Well- .. . ...... . ... Foundation __ Property Line .. ....... ..... .............. .. SEEPAGE PIT ( j Depth .... Diameter.. . ... .._Number.... ...... .... Rock Filled Yes❑ No❑� WaterTcble Depth . .. . ... ............ .. _ ... ...............Rock Size--. .. _ .- ....-..-...........-....-...... Distance to nearest: Well Foundation . _ -_.._.'. Prop. Line. ......................... �D REPAIR/ADDITION (Prev.Sanitarian Permit# . . .. ........_...... ...............Date. ..... ------- -) Septic Tank (Specify Requirements) _ _ ............. Disposal Field (Specify Requirements).�r r+�•��t E ..... .i(.•��, .....,.Vic.... _4= -G.•�:(._.y� cLl.,`4. .:...c: x L. -_ _................. ................. .... ..... ................ ...- ........... . - .. ....- .. .... ... ... ... ............. (Draw existing and required addition on reverse side) I hereby certify that 1 h�jve 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 licensed 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 ✓tel/. c;�l<"jt .. Title By- :� (If other 'Eon owner) FOR DEPARTMENT USE ONLY =-moi-- __----- ---------------------=' ----- —_--_-_-----_ — -- -------------------- __- APPLICAT-ON ACCEPTED BY /�C� ` // i DATE DATE DIVISION OF LAND NUMBER �! ADDITIONA! COMMENTS `rZDote / 5-z 7 Final Inspection by: / �� -C AUL✓ EN 13 2` SAN JOAOUIN LOCAL HEALTH DISTRICT r35 71677 cru. Ana vn