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FOR OFF1q- ,USE: . ..... APPLICATION FOR SANITATION PERMIT . . ......... .... 7S-oL o 2 (fompleta in Triplicate) Permit No. ......... ........... .� This Permit Expires 1 Year From Date Issued Date issued . . 3"7J Application is hereby made to the San Joaquin local Health District for a permit to construct and instal[ the work herein described. This appli otion is maa,L��in cymplionce it unty Ordinan No. 549 and existing Ruff s and Regulations: JOB ADDRfSS/LOCATION ... 7.`. .. .,..!. ...... .. r l....................CENSUS TRACT .... ,r.ter:..:......... Owner's Name . . ..rc........ _ ........................................................................Phone ......... .......................... Address 7!f .. 1Co - City .46Z x !�< " ... Contractor's Name .. ... ... ....' y� Lianas iw ..��. ./. ... Phone ... ..f� l ? Installation will serve: Residence❑Apartment House Commercial❑Trailer Court r) Motel E]Other........................................... n�1 LL Number of living units:...-.j.... Number of bedrooms ...3......Garbage Grinder ............ Lot Size 1. �..X...�?7Ll..d........ Water Supply: Public System and name ...............................................................................................................Private❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat 0 Sandy Loam ❑ Clay loam ❑ Hardpan❑ Adobe Q Fill Material ............ If yes,typo_............. ............ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverseride.) NEW INSTALLATION: JNo septic tank or seepage pit permitted if public sewer is available within 200 feet,[ ��11 PACKAGE TREATMENT [ ] SEPTIC TANK I ] Size.............../..�I.(�Yl................. Liquid Depth ....:1.:................. Capacity ..i.Avo.. Type . Material... .- No. Compartments s............ Distance to nearest: WeT—/.0.0.......................Foundation ...../17.......... Prop. Line .....L V:......... LEACHING LINE [ ] No. of Lines'. 1,k- - _. . Length of each line........ a..... ....... Total Length ..../. 7d-. ......... 'D' Box . . Type Filter Material Depth Filter Material .....1.5F............................J • Distance to.nearest. Well .... Foundation -----/.19........... Property line ......d^ SEEPAGE PIT ( J Depth ........... Diameter .... ........... Number __2,.._.......��.. Rock Filled Yes ❑ No ❑ J Water Table Depth ...... ..... ...................................Rock Size ._�..r ........:........._ rn Distance to nearest: Well ........................................Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prov. Sanitation Permit# ....................................:....... Date ..................................) Z Septic Tank (Specify Requirements) . . .. ...... ..... . ..._..................... .......... ................--...............I........._............... 0 Disposal Field (Specify Requirements) ........ . ......... -......•. ...-- .......'..:.......;M1... ... ...... ---................•------................._.....,................ ...... ---------------- ----------------- ........-..... .....--- ....._...................................... 9 ..._..._ . _.._....... . ....................._.... . .. ............_.- --------- -- ......................................... . ----- ............................. . . 7 )Draw existing and required addition on reverse side) I 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 Son Joaquin Local Health District. Hems owner or Iicen- sed agents signature certifies the following: "1 certify that in the performance of the work for which this permit is Issued, 1 shell not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed .._........ .. ... Owner By ..............__..- .... .. . 3itIe (I oche than ow r!�" DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.. .__ 1. .... ... ..................... DATE . _� __... .7 BUILDING PERMIT ISSUED ... ...... -.. .... .................................... --.. -- -- .......DATE .......................................... ADDITIONAL COMMENTS .................................... �- ....._..................... _......_.......... -- .. ......._. _ Inspection nsp ctio.......... ..... .... ... .. _. . .. ......................._.__-------I............. ... . . ......... Finallnspectionby: ... ... ... ..._.......................-------------..._..Date ......_ ,._ _..... .. .......... EH 13 211 1-613 Rev. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7]J 3M