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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT . • Permit No. .:7�-._._._..:� (Complete in Triplicate) ............. ......... 6- ..... -------- Dot*Issued 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. a- JOB ADDRESS/LOCATION 4/4Z/ . c.. . ........ = CENSUS TRACT __.. _ ! .................................Phone �� - Owner's Name Address ... . . ..........----. ............ Cit blcTo. Contractor's Name .- -�. .c A License # -.-.... .. Phone ..`t`. .��..:/-�d Installation will serve: Residence (Apartment House❑ Commercial ❑Trailer Court b - : .Motel ❑Other ......:..--------............. •-. - r � Number of living units:.. ./....... Number of bedrooms .. gPeot �G�nJi9d r /_/(] . . Lot Size . �.._ _-� •.•.•--•-'•- Private Water Supply: Public System and name - ------------------------------ Clay ----- - --....._....._._......_..._ ❑Character of soil to a depth of 3 feet: ISand•❑ Silt❑ C ❑ Sandy Loam ❑ Clay Loam; Hardpan ❑ Adobe Fill Material _...... _:.. If yes,type ----....... . .... ry.. (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) J NEW INSTALLATION: lNo septic tank or seepage pit permitted if public sewer is available within 200 feet,) !` PACKAGE TREATMENT [ ] SEPTICTANK� Size.. ------- - -•.. Liquid Depth .-�.._./.�............_:__ Capacity- co.-- TypeP,.a_=.&A,._ MaterialG _._ No. Compartments ....h�..............� Distance to nearest: Well f o.�l c.- --_Foundation .....L.0-........_.- Prop. Line _.... LEACHING LINE No. of.Lines . g line . a.�. 9 - ... Total Length _........© ............ .: Len th of each I c� . 'D' Box . _J� Type Filter Material .Depth Filter Material ...- ..1.8 ....................___.._.. Distance to, nearest: Well .. ori ..--. ' � .. I r _ Foundation .. /...C?..._------ Property line•--- -------------------- ZZOrf CD SEEPAGE PIT K Depth ------ Diameter Number '. Rock Filled Yes No p � t _______Rock Size -.�.Z��- n Water Table Depth: ----��..�" . --------- _ ._�':...----- P Distance to nearest: Well .._�l? P:` ..................Foundation ...�.[� ` Prop. Line ......� ...._..: REPAIR/ADDITION(Prev. Sanitation Permit# ----- -. .- ............ Date ..... ....................... L .Septic Tank (Specify Requirements) ...... -- ---------------------- ..............................:............._.-. ... ------.._---- Disposal Field (Specify Requirements) .----_------------ ---- ------•-------------- ......................... --------- -------- -------- ---------------- ------- .......-- -- -------..... ............ _ _ r (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 :I and Regulations of the San Joaquin local Hogith District. Home owner or 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 an's Compensat' aws of California." lf� Signed . .QD 0. `a. . ...!A.f'�.C2.1 SW.-`f -Q-t",LS• --....----. (If other than owner FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . x .f -- -. DATE b �,�. -7.7S... ._._ BUILDING PERMIT ISSUED .. -. .. - . --..._ . .. .. -DATE . ADDITIONALCOMMENT ..._ .. . d --- ----------- --------- -- - -- - ----- ------------ - --------- ------------------------------ > �� - .... . .......................... ........................... ..-... . ..--- ............. ; - Date .- Final Inspection by: ..._. ,... - . 44,/- - p SAN JOAQUIN LOCAL HEALTH DISTRICT C L, 13 24 1_-AQ D_ x.. 7/723