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FUR OFFICE USE: / APPLICATION FOR SANITATION4ERMIT -.................---------- -- ---1-f---4-Z.__ (Complete in Triplicate) Permit No. 7i This Permit Expires 1 Year From Date Issued Date issued 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 ADDRESS/LOCATION . _ r*/`_ CENSUS TRACT ..__--------__...__-___ Owner's Name .- - __&A --�-----PT✓,01W------------------------------------------------------__---------------Phone .7-5771;W..----------- Address - G?<`` --------------- ---------------------- - ---------------------------__.....city �Ll i7Z/ --- Name ------------------------License # 12�'r -!------ Phone Af.:5.a�.lr.`__ Installation will serve: Residence-0 Apartment House❑ C mmercial❑Trailer Court ❑ Motel ❑ Other ---Atokleha?Y_G__.__.____ Number of living units:----/------ Number of bedrooms ...2-----Garbage Grinder /51¢__ Lot Size _ / lf__________________ Water Supply: Public System and name ------------------------------ ------------------------------------.......--------------------------------..PrivateJ91 Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe jj 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 seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC Size_ XS�7-. ----------------_ Liquid Depth Capacity/"_lt� _ Type �C.467__. Material_ No. Compartments ....._............ Distance To nearest: Well _.. --__-__...............Foundation ---As_�...._.._- Prop. Line _S_r.._-----.... LEACHING LINE [�] No. of Lines __----/------------- Length of each line.-/,,V- --- Total Length -__.___._ 'D' BoxWC1._ .. Type Filter Material . AC/C_..Depth Filter Material -Ifi----------- -------------------- � Distance to nearest: Well ___ -------- Foundation ..?d_- _._..__- Property Line _.S-............. SEEPAGE PIT kf Depth -Fi ---- Diameter Number --------- ------- Rock Filled Yes_4� No i❑ in .. Water Table Depth ------30-92--- Size -�i�--��............-. � Distance to nearest: Well -----/ 0..r.. ------.____---......Foundation __-__..._ Prop. Line .5�____------------ REPAIR/ADDITION(Prev. Sanitation Permit# _..___..----_._._-..._.._.._.._....__ Date ----_____________--..-._.-._.._I � Septic Tank (Specify Requirements) ------------------------------------------------ -----------------------_..... --------------.. Disposal Field (Specify Requirements) -------------- (Draw existing and required addition on reverse side) 1 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. 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, Ishall not employ any person in such manner as to become subject to ork a ' Compensation laws of California." Signed -.......---- ------ -------- -- - - --- ------------------------------------._..._ Owner t r By -...... - s ..................... - . . - Title - -------------------- - -- - - p er th n o ner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY I ------------------ - ------ ----------------------- DATE ------g -� 7_/---- ------ BUILDING PERMIT ISSUED ------ --- ----- ---------- ---------------- ---------- -------------...._DATE - ADDITIONAL COMMENTS ---- -- ---_---- '---------- - - --- - --------- -------------------------- ---------------- / ----------- ---------------------------- Final Inspection by: -'---- -- -` - �`�j(- - - ------------ -----------.Date SAN JOAWUIN LOCAL HEALTH DISTRICT F L.1 a 1 'AQ D.,.. FAA