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�i � a FOR OFF��E USE: APPLICATION FOR SANITATION PERMIT ----- �_i ---------- Permit No: 7ZS__- (Complete in Triplicate) i�' Date Issued . /S'_7.Z ------------------------------it-------_----------------- This Permit Expires 1 Year From Date Issued Application ill hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein s described. Thi`s application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .----7/_0------ .___ --------------------------------CENSUS TRACT -------------- ----------- JOB f rt phone ---- Owner's Name ------�1;Ld �--�e-��-5----------------------- -------- p� Address ----- '" ,� -----�7,---- -7f -e- city, Gil �rx� -f _.. Contractor's Name _ __�� __ ac-__. _-_.License.# - s .3 Phone __________________ Installation Dill serve: ResidenceApartment House❑ Commercial :❑Trailer Court � . Motel ❑Other Number of living units:-.-/------ Number of bedrooms _2-- __-Garljage,,Grinder ------------ Lot Size ---------- Water Supplj1,1: Public System and name - -- � _-. (,t i A_1 ------------------------------------------------------ ------Private ❑ Character of 'soil to a depth of 3 feet: Sand❑ Sift E] Clay E] Peat❑ Sandy Loam ❑ Clay Loam El, . f! Hardpan ❑ Adobe Fill Material ------------ If yes, type _____.___________________ (Plot plan, showing size of lot, Iota#ion of system in relation to wells, buildings, etc. must be placed on reverse side.) !Ili NEW INSTALLATION: (No septic ta6k or seepage pit permitted if public sewer is available within 200 feet,) Q PACKAGE TREATMENT [ ] SEPTIC TANK f] - - -Size-----------r------------------------------------- Liquid Depth -----_----------_---,_---- ($ Capacity ---------- -------- Type -------------------- Material----k- ,T----------- No. Compartments ---------------------- Distance to nearest: Well ----i------ ---------------------:Foundation ---------------------- Prop. Line .--------------------- LEACHING LI ,' No. of Lines ____�_!_____________ Length of each line--., ............. Total Length 4,10-47 ........ rr __. = 41ei (t5 ,�r 'D' Box .6 A.)-- Type Filter Material _____ '__AC1Depth Filter Material ---X�_________ Distance to nearest:'Well Foundation .__/O-_r-_______ Property Line __S----_____________ SEEPAGE PIT: I [ ] Depth -_- -...........Diameter ___ .�____ Number -_-_--/---------------c_Rock Filled Yes No C i Water Table,Depth.- =64 7--- - -------Rock Size ---- Distance to nearest: Well ._____--'_____________________________Foundation -------------------- Prop. Line ..--___---______-__.__ REPAIR/ADDIS ION(Prev. Sanitation Permit# --------------- ----------------------------- Date ---=____-__________----__- -____) Septic Tanks(Specify Requirements) ------------------------"_ ____________E ----------------------- Di osal Field (Specify Requirements) =- - "- � --- - ------ ` .G S ----•--------- -----k-333- � � --- -------------------------- -------------- ( "aw existing'6hd 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: F "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 s 'ect to Workman's Compensation laws of California." Signed -------- - ------- - '------ -- ------ Owner B 'I' =- _ - i a: :Title":.y ' --------------------------------------------------- o her than owner) Y i FOR DEPARTMENT USE ONLY APPLICATIONI ACCEPTED BY - -- --------------------------- DATE 3_`.-__ BUILDING PERMIT ISSUED --------------------------------------- ----------- ---DATE ------ ------------------------------------ ADDITIONALJICOMMENTS ------------------------ ------------- - -----------------------------------------------------------------•----------- --------------------- -------------------- - 3----� � ------------------------------------------------------------------------------ --------------------- r----------- ---------- ----------------------------------------------------------------------------------------------- --------------------------------------- li S N JOA N L ---------- -------- --- ----- --------------------------------_-_----- -7- ---------------------------------Date Inspection by: ...... ---ll- OCAL 7/ HEALTH DISTRICT F_ H_ 9 1.'AA RPv_ 5M y