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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT � .........-rs......................... I Permit No. �- ICom�ilete in Triplicate) ........ .......:..... ............... 7 This Permit Expires 1 Year From Date Issued Date Issued _...::...-�-....Y 11 Application is hereby made to the San Joaquin Local Wealth District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 544 and existing Rules and Regulations: , JOB ADDRESS/LOCATION ,._.. �`_ •-,•.� ,.....Ze A - • 60 e - ..... ...CENSUS TRACT ..................... W...> ........ ............Phone ................................. Owner's Name ..... ... -- Address .. ..... .. ................... City �.•-... .._ Contractor's Name _. :.. 1:....•( .....................License # ��r�-7.�---•• Phone Installation will serve: Residence { Apartment House Commercial ❑Trailer Court Q Motel ❑Other --------------•• ....... ----_---- ....... Number of living units----- Number of bedrooms _...;-_Garbage G�Indder .._. Lot Size _J _.- •......•-••- Water Supply: Public System and name ........... ......... .. ................................Private !:. Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 0 I Hardpan ❑ Adobe Fill Material ............ 1f yes,type -_-------_---_------_- (Plot ------.--______________ _(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 TANK I ] Size....................--•---.....�....---------... Liquid Depth .......................... Capacity ----------------•--- Type .................... Material.--•-•--•----I� No. Compartments ...... ........... W Distance to nearest: Well ..............................Foundation --__-....__...._...... Prop. Line ...................... LEACHING LINE No, of Lines ........................ Length of each line--------------............. Total length � 'D' Box _........... Type Filter Material __-___:.............Depth Filter Material ........................_...............__-: Distance to nearest: Well ........................ Foundation ....... 11-................ Property Line -------................ . SEEPAGE PIT [ j Depth Diameter ................ Number ...... �...._._......... Rock Filled Yes ❑ No Water Table Depth ..............................................Rock Size .. Distance to nearest: Well ........................................Foundation -------------- Prop. Line -----------........ ~• ff l REPAIR/ADDITION(Prev. Sanitation Permit�# ... ------------------------- ------ -_ Date -------�l..._.........•---•--••-•-•) t /J��,�� d �I Septic Tank (Specify Requirements) --- .�.CQC�L-._�..--_-- ----- `-�--��..... .. .Disposal Field (Specify Requirements) ---=...............-......................................................•--------.._..-----------•-•••;--..........----------------- --------------------------------------•----..._.-_......------------------------------ ------...---- ...... ...............................I........................ --------------------------------------------------------------------------------------------- --------•----•--••-•-----------_._.__.._... .............................................................. (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. Homs owner or licen- sed agents signature certifies the following: !� ik "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," Signed F..... ....: caner �•� � O s 8y�� _ ._ :�f : "•.............. Title ...-_. Cs (If other tha owner) i FOR DE RTMENT USE ONLY APPLICATION ACCEPTED BY BUILDING PERMIT ISSUED .............. ........ ""� ---------. ....._-••• .......-•-•-•---�( -----.......DATE --__... ADDITIONAL COMMENTS _..._... ... .. -----•-- ......... -._ . .. � �`� y ::::::::::::::::::::::::::::::::::::::: :: :: :: : :: ::::::::::::::.....:::::::..........................--.......::-::_:_::::::::............ ..::::::.. ............................... . _. ............ -- .._...... �I Final Inspection by' _ . .___ ..i�..............Date - j _.� _ SAN tJQUIN LOCAL WE7TW DISTRICT _ ,I9L _ ..- - _.. 7/773M