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FOR OFFICE USE: . r a .. ........... ( ''?PLICATION FOR SANITATION PIcnT lCompiete in Triplicate) Permit No. ..7. This Permit Expires I Year From Date Issued ed ..�-'��—•7V Application is hereby made to the San!Joaquin Local Health District for a permit toQrQnPinsYtthe work herein described. This application is made in compliance with County Ordinance No. 544 and existing Rules and Regulations:e n JOB ADDRESS/LOCATION.... --................. CENSUS TRACT ._,. ---.----- + Owner's Name ....... ... Phone Address e ....- .............. . '.. .. r city ...... L- - ._ � . :-- ............ ..Contractor's Nome .._.Licens # -- � � Installation will serve: Residence KAportment House❑ Commercial ❑Trailer Court ] Motel El Other ............................................ Number of living units:............ Number of bedrooms .._. Garbage Grinder Lot Size ......&_Z'_ ...... ... . •---- --•- -............... ........................................................Private Water Supply: Public System and name ................ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam 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: INo septic tank orsee ge pit permitted if public sewer is available within 200 feet,) , PACKAGE TREATMENT r'X9',r 5 ' -r [ ] SEPTIC 'TANK .� Size. ?} !.Y- --x.-�'..................... Liquid Depth y. �'o a g��. --•-• .. ................. Capacity �„? �.i.l.- Type�i -2 r., ...--- Moteriol..(2r:?,f. .---. No. Compartments - ....... ,, Distance to nearest: Well ............P� ? f`':......Foundatior�.._/� .- _'_: Prop. Line .. . -� r LEACHING LINE [ ]I No, of Lines ...... ............. Length of each line-----,cam __.'............ Total Length'D' Box Bax .__- Type Filter Material ..._5�-------Depth Filter Material ........ Distance to nearest: Well .......4 ---7 -•------.. Foundation ....!_�?�:...... Property line ....� --••--• y [ ) Depth Number a Yes No --.. ... ._._.._� ..�....._ Rock Filled [� O+ Water ' Table Depth ............. 5A-------- --• -..Rock Size _.. .. . Q' � ��-X•-•�------.. to Distance to nearest: Well ...... .__--- Foundation ......... Prop. line ..... �- E aREPAIR/ADDITION(Prev. Sanitation Permit# .._..__.............................•••... Date I ...... 1 Septic Tank (Specify Requirements) ..................... Disposal Field (Specify Requirements) (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 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, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." +'yj Signed ............•---- - ' f': . Owner BY -......... ......... .. ....... .... .. Title ...... If other than owner) ........ "'--'--"""'--""'-"•` FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED B -- �+•--•-- -- . DATE .. -- •-•7 1 BUILDING P ....-----•----.._.. ------ -----•-•-- ERMIT ISSUED - DATE ti ADDITIONAL COMMENTS - - ........ 't. ...................--•.....---.......... -...-- ..... _.:.._......... - - - - .inal Inspection b ............................................----••................ .i....�. - --•-- ------- Dae :1 _. ....•-•....-•-•- SAN JOAQUIN LOCAL HEALTH DISTRICT 1.3 24 H. 1-'BB Rev. 5M 7172 3 .tit