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FOR OFFICE USE, y APPLICATION FOR SANITATION PERMIT f ....`.......... .. ....... .1. .................... (Complete In Trlpllcah) Permit No,7�.. Q/..�... ........................... .... ................... Data Issued... this Permit Expires 1 Year From Date Issued ,1�- 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. 544 and existing Rules and Regulotlons: JOB ADDRESS/LOCATION ...1�°.T.. `'.....................%N L1 � l',s {�r/tie s YY! c7`..C1:NSUS TRACT .......................... Owner's Name ........... Q.ft y.T........... Al.A................................... ... .......................•...........Phone . .e�. '...... ..`..:........ Address ... ...... .5:.a /lI�_ Ac/Jew---...14ve............................City ............ .................... / a!ir �' Sa/1� ............... License /6b-S_ .6.._. Phana .S... 3 y I;7 Contractor's Name --------- ...!#�T .... J� ... Installation will servos. Residence(,a Apartment Houses] Commercial❑Trailer Court ❑ Motel❑Other...................................... . Number of living units:..... ..... Number of bedrooms .A......Garbage Grinder ------------ Lot Size .._� f�Cy ................... Water Supply: Public System and name .----._ -- -_- ❑ ---------- -•----.. ..�_----•..............._._.._.._........_...... ......_.._............._Private � • i Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ day Loam Hardpan❑ Adobe❑ Fill Materlai yes,type (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side-1 NEW INSTALLATION( lNo septic tank or seepage pit permitted If public sewer is available within 204 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK( ] size......... 6 ba... " A Liquid Depth -_-_-.'1�:s: '........- Capacity . Type - rr.C. sr Material... No. Compartments ......... Distance to nearest: Well ...Foundation �° Pro Line �d -•i pa -- - ......... p. LEACHING LINE [ ] No. of Lines ---:3.............. Length of each hne..... .................. Total Length -X2.0.................. , 'D' Box ...... Type Filter Material / -`'! a52�Depth Filter Material .... '_••.............................. Distance to nearest: Well �4a '� ._---.. Property Line .-.:�`a -----• �._._.... Faunda?ion ... -•-- SEEPAGE PIT 3 Depth Y.. ' Z_.�' Diameter Number - ..... Rock Filled Yes IM No 09 Water Table Depth ----•-•------•-•--•-••..........................Rock Size --- ......... Distance to nearest: Well ...... Prop. Line ---------------- •--................Foundation .............. ...........---------. REPAIR/ADDITION(Prov. Sanitation Permit# ............................................ Date ..................................] SepticTank {Specify Requirements) ......................................... .,......................_.........................-•--•.......- ...-........._................ DisposalFiela (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 taws, and Rules and Regulations of the San Joaquin Local Health District. Home owner at licen- sed agents signature certifies the following: "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's Compensation laws of California." Signed ...... 4-°,V........................................... Owner By ....... 71_. .: --------------- - . yitle ........ (tf o owner) FQ"E!MTMENT USE ONLY APPLICATION ACCEPTED BY ....... .... .. ....................................... ........... DATE ./.. ..��..--------- BUILDINGPERMIT ISSUED ...... ....................................................................:?............._.._._...----...DATE ....... ................................... ADDITIONALCOMMENTS .............................................................:...........I............... ......................................... ............................................ ................... .. ...... _. -- --- -•---....... _.._........._......_........_..... _........... ... ... Final Inspection by: r - Date .r.4� ,� .. ............. ,, � _. ..... �- .... .. .. ... .......... ... .. . gi 13 2h •'"bit✓ Re - 5)1 SAN JOAQUIN LOCAL HEALTH DISTRICT 6/7h 3M