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FOR OFFICE USE: 7_ � , i APLICATION FOR SANITATION PERU .,.._------------------------ ....._. - . 1 ....... (Complete in Triplicate) -- Permit No. .... This Perm itExpires 1 Year From Date Issued Date issued :'`!�—•-3 Q- 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 ADDRESS/LO ON ...�. _Z.✓�._ �-. _. iU �/ r ...........................CENSUS TRACT Owner's Name -C ......... Address .- _ _.'City .�.C,J - Contractor's Nome J: rl' ................ ... ---- --- 'cam__..license # .._1 r r ZPhone -••-:--• Installation will serve: Residen ' El Apartment House C mercia) Trailer Court Mote! Other . . - m--------------- FILE COPY Number of living units:-.------- Number of bedrooms --_--.-----.Garbage Grinder .......... Lot Size ..._.._....-•__-- :� Water Supply: Public System and name ............ . - -- -•----- --•------•-----•---•............... ❑ ._.....Private Character of soil to a depth of 3 feet: Sand Clay Silt ❑ y ❑ - Peat❑ Sandy loam ClayLoam Hardpan❑ Adobe:El Fill Material ....... If yes,type ............................ I (Plot plan, showing size of lot, location ofsystem in rglation 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 TANK Size----------------•-•-----• - Liquid Depth ' No. p Capacity YP Material............... -- -------------•--- Type .....-•------...._.. Com artments Distance to nearest: Well Foundation ..• ... ---.-•-•• Prop. Line ...... 'LEACHING LINE ----.....-- ...................... ( ] No. of Lines _.__..- length of each line............. ........... Total Length V..Box ._.:.._..--• Type Filter Material ---------Depth Filter Material' .Distance to nearest: Well ----�Foundation _ --------------•----•--'...._..._........-_-. .................•• --•-------- ----------- Property 'SEEPAGE PIT [ ) Depth _-_ Diameter ... Number e .................... "—' . Rock Filled.d Yes [] o Water Table Depth .....Rock,Size Distance to.,nearest: Well ..................... .::Foundation .. Prop. line REPAIR/ADDITION(Prev. Sanitation Permit�# ................ — — ----••--••---•--- Date Septic Tank (Specify Requirements) __..:_...__... ......... ...:------.... ....... -----... Disposal Field (Specify Requirements) ....... --- � ..s .. ,. _ I . ------- .----- Ira- w existing and required addition on reverse side) I 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: 0 "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 become subject to Workman' mpensation laws of California." Signed ---....:................. • ----•- --- By_........ ........ Owner .......................• ci 4 (if other than o title" FOR•DEPARTMENT USEONLY APPLICATION ACCEPTED BY .._ _ BUILDING PERMIT ISSUED •............. ADDITIONAL ..DATE _ _ Il COMMENTS --•----••-•------•--•-----•----•-- ..•---•--•--•- ...................•---...... Fina; Inspection by: ...: ;.S. a . .-. .. - Date ...... SAN JOAQUIN -LOCAL HEALTH DISTRICT 11 24 - r��