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FOR OFFICE USE: I .......................................................... APPI.ICA1'ION FOR SANITATION PII:RMIT 7 �3 (Complete In Triplicate) Permit No. .7................ ' This Permit i:xpires Year Prom Date.bstted bate.lssued . .`�`j`.77 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 LOCATION rr�� +.L_��•a..L... . ".E ....2.7.-r.............. Ar/ ?..�.rt/..........CENSUS TRACT ......... ........ f Owners Name �J�" ••...��• •r fmS.�_ Cl2lf ................Phone .4... 3.--Aa...9 Address . City s� 1�7 ................. ..._. -- 7d7�.leff�. . Contractor's Name ........... ¢r�.[_. �LG.License R�QaVc3.. Phone --'17 p��.. r 94 --.....-_ installation will serve: Residence OQApartment House❑ Commercial ❑Troller Court ;❑ 4i-Motel-EI-Other .. ........................ . , Number e5p bera # living uniits:_.. .�_.. Number of bedrooms Z....Garbage Grind r .; . .:.. Lot Size ply: Public System and name ............ ......... .. i.�tslf�`. .!>~_..:��. -•-• .�_�. y • ................Private ❑ Character of`soil to a depth of 3 feet: Sand❑ Slit❑ Clay ❑ Peat❑ 1.1 ndy Loom 0 Clay Loam I :Hardpan ❑ Adobe P' Fill Material ............ If yes, (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 ] Size.................... ........... Liquid Depth ................ Capacity ........... Type .................... Material............... .....• No. Compartments ' Distance to nearest: Well "------ .. . ..........Foundation ...................... Prop. Line ...................... LEACHING TINE ( No. of Lines -----_--- - -- ------- Length of each line............................. Total length 'D' Box .._......... Type filter Material .............. ....Depth .i=filter Material .........-------•. ... .. . ........ F; Distance to nearest Well...................-:._ Foundation .._.- Property Line(' ......................... ... ... .. . . . ........ SEEPAGE PIT p Rock trilled Yes ❑ No ❑ ( 1 Depth Diameter ----•- •--.•--- Numbt � . f Water Table Depth _ Rock Size :................... Distance to nearest: Well ................................. .....Foundation .................... Prop. Line ....................... REPAIR/ADDITION(Prev. Sanitation.Permit# ..--._ =..__......................' Date ..................................I Septic Tank (Specify Requirements). �- ----Disposal Field (Specify Re utrements __fi. ....... � . r _- -�.. ,(Draw existing and required addition on reverse side) I hereby certi t I have preparedthis application and that the work will be done in accordance with San Joaquin E County-Ordinances, State Laws. and Rules-and Regulations of the Son 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 peirmit is' slued, I shall not employ any person In such manner as .to be me su.to Workman's Compensation laws of California." Signed _ - B xt Y ----------- I t OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ DATi _. ...:1 BUILDING PERMIT 'ISSUED . •------ - -- DATE ADDITIONAL COMMENTS .___te- 7-?". 7 �, .. ........... /- ----- - _--. -- .---- - •` .ate f ��, -—._ . _ T _ - _-� _. _ --------- _._..._.. .............. ..... .. __. _...-__.._..._..______.__._.____.._-_._.- - ' .p+ mow....-� . a.. • ..:.......... .......... ................ . .... Final Inspection by: -------- - --•- - -- •. ...............................•----.......__....--- . _....-•-----------•--..._Hate . .. ._. .. EH 13 24 1-68 Rev. s � SAN JOAQUIN :LOCAL HEALTH DISTRICT 8711 3M Cry