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.. ............FOR OFFICE USE: ... .... APPLICATION FCR SANITATION PERMIT .f��t (Complete In Triplicate Permit No SL i This Permit Expires t Year From Date Issued Date issued v. .orf 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/k-CATION .--. -dam .. -y-� Q/,�.�,( ..c:/,TTs�� .G.... .CENSUS TRACT .......................... Owner's Name f. - At..... .................. .,... ..._....Phone � Address / .. ..........�...._..--••-------•---- ..-- 1 u�7`.�%E _ �......_..---•......:...... CitY :.�.. /� y y C,�s1`,r ................... Contractor's Name ...ek;eJVF,e—„ ---------License Phone -e :&L8!$&P Installation will serve: ResidenceXApartment House fl Commercial[]Trailer Court 0 - - --Motel fl Other.-.. - _ - . .� - . ......................................... Number of living units:_/------ Number of bedrooms .:Garbage Grinder ------------ Lot Size --_7'T.-ole,C.`}�}................. Water Supply: Public System atld name ....... --— 1 .Private [] Character of soil too depth of 3 feet: Sand o Silt[] Clay .0 Peat❑ Sandy Loam o Clay Loam o Hardpan ❑ Adobe 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 yr-seepage pit permitted if .public sewer is available within 200 feet,} PACKAGE TREATMENT [ ] SEPTIC TANK[ ] Size------------------------------------------------ Liquid Depth ..... _._.................. � t CapacityType -------------------- Material---------------------- No. Compartments Distance to nearest: Well ------------------------------------Foundation .- _--.---.._-_..... Prop. Line ...................... LEACHING LINE [ ] No. of Lines --------/----_------ Length of each line------ .... Total Length _fid.................. i D Boxelo�) TypeFilter ..4. .-.. Typilter Material _�.Z ..Depth Filter Material ...... c e�........................... Distance tp nearest:-Well"A__11.foundation #<Q.. ' ._. Property Line .......... SEEPAGE PIT [ ) Depth - - ...... Diameter __33...... Number ..-------/................ Rock Filled Yes Water Table Depth _./ra .r....-._ -_-- -Rock Size Distance to nearest: Well ...........Foundation ___lQ____...... Prop. Line _ ---------------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date .......................-----------3 Septic Tank (Specify Requirements) .................... .............. :..................._:. Disposal field ( pecify Req mems) _._ X-.2 ��. x --------- / .................. #Draw existin and re .aired 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 licen. 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 beco ubject to W kman's Ca ensation laws of California." Signed ---- ---• --- --- - �...--.. Owner By --- ----•-------- -•------ Title -------------------------------- (if er th ner) I FOR DEPARTMENT USE ONLY ` APPLICATION ACCEPTED BY -- DATE- �lJ=_% -Z .. ................ BUILDING PERMIT ISSUED ---•-- -- DATE ..................... ADDITIONAL COMMENTS ..------•------•-- ----------------------•------------------------ - - -------- ------------ ..................................... final Inspection by: ..-- Date EH 13 24 -b fie' SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M ,