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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7S'- (Complete in Triplicate) Permit . ........... ------------------- This Permit Expires ] Year From Date Issued Date Issued 02-1^- 166 -fe Application is hereby made to the San Joaquin Local Heolth'District'for a per 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 �..CENSUS TRACT .......................... Owner's Name .. �. . a - ^. ........................_.... �.._....._.=..- ' ...............Phone ....................._......a....... .... . Address . .. ... -']� ......................................................... City : . ._........._...._................ r J Contractor's Name Aa i k--9,AL-:1. •--------------License #AMF.7-...... Phone .............................. , Installation will serve. Residence Apartment House Q Commercial (]Trailer Court Q Motel Q Other ----•...........................••--••.....: Number of living units....... Number of bedrooms .......Garbage Grinder ............ Lot Size ... - - -* rr.--..-.-: Water Supply: Public System and name .............................................. ----------_......................I.............................Private j Character of soil to a depth of 3 feet: Sand Q Silt❑ Clay gr Peat Q Sandy Loom Q Clay Loam Q Hardpan ❑ Adobe Q Fill Material _.... ...... If yes,type............................ (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 see age pit permitted If public sewer is available within 200 feet,} , PACKAGE TREATMENT [ ] SEPTIC TANK[V� Size. �� ..`l_'. .�. . .. .. Liquid Depth ...y............I...... Capacity Type . Material__. �......... ... No. Compartments ... , ..... Distance to nearest: Well ..........%1;5r :_........Foundation ......./A. Prop. Line,__.._.... ' [ .3..__....... Length of. each line.-----I?. °`....... Total Length ../_,` A ./ LEACHING LINE Na. of Lines ___.._. . _......_ G , D' Box ,� Type Filter Material = '" p _. ._.... ..... ...... ...De Depth Filter Material .... P Distance to nearest: Well ......�r44e..... Foundation ....-�.�. - Property Line ......, ...... SEEPAGE PIT [Y� Depth ..._. .5 " Diameter 42.0..... Number .........r3............... Rock Filled Yes 0 No Water Table Depth 0.l1• •..................Rock Size I , -- --y..._... 1 Distance to nearest: Well ........4a R.kr................Foundation `11.`� Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ) Septic Tank (Specify Requirements)`--------------------------------------------- ------------------ Disposal Field (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 Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or iicen- sed agents signature certifies the following: "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 ............................... Owner By ................................. . .. :.�..Q ---- Zitle . �Mr21....... . (If other than owner) „ � FOR DEPARTMENT USE ONLY _ APPLICATION ACCEPTED BY .��....!�1� .............................................................. DATE _q.::�b..... .7 ..._._.... BUILDING PERMIT ISSUED ----- .. ----------- ----------------- - --- _.............DATE ..............................-----........ ADDITIONAL COMMENTS ...............I..........I............................................ ....................................... .. .e....•---.... ......... ............._........_..........•--•-•---•------.._..............-----------------•----..............................._.. -------------------------------------- ... :.....................././.............................................................I...................... .......------- Final Inspection by: -/..:fib.. :_ S _ /� .-- / 1.-•- ....Date ..-/.. SAN JOAQUIN •LOCAL' HEALTH DISTRICT r .. 7 q 24 , n--- �,:'` 7177 K