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- FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. �(Complete in in Triplicate) ......... ........... ................ 1 1 - Date Issued .--_�.��•� This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance NNo.. 549 and existing Rules and Regulations. JOB ADDRESS/LOCATION :_. �-•7.7 . - `— ...........CENSUS TRACT :...... .. r Owner's NamYlrJ... ' t t ...... ......Phone ez . ................ �' "-- CitY s � - --........ . ..---. . ......_....__._ ... ---Address ....... � - -�- Contractor's Name .. . . .i . ..5".... G1yS .e.... _✓-'-4J---- - ....!-.License # o?�a./aZJ-�--_ Phone .. Installation will serve: Residence ❑Apartment House, �Commercial KTroiler Court ❑ Motel ❑Other . `"i 1 mber of bedrooms ....._._._._Garbage Grinder ..._._...... Lot Size Number of living units:.. ......... Nu EEEE Water Supply: Public System and name ................... ...t._. i,----- Private Character of soil to a depth of 3 feet: Sand❑ Silt El Clay Peat, Sandy Loam C] Y Clay Loam Y C er - " -p +- Hardpan ❑ Adobe ❑ - FilfMaterial .".........- If yes,type I I (Plot plan, showing size of lot, location of system in relation t ell%buildings, etc. must be placed on reverse side.) r NEW INSTALLATION: (No septic tank or seepa pit permitted f pubic sewer is available within 200 feet,) ' J PACKAGE TREATMENT [ ] { Size.... r�-y Liquid Depth ..._. ---� SEPTIC TANK . y - • -�-� a.... . UHLI...... �!L-��? No. Compartments Capacity •��-�C7 p� "r `t' � �. ' t Foundation .... Pro Line ---- -------- - stance to nearest: Well .*�-•--- -------- ---!_.1-- p' �. - Gr � line. � .. Total Length ._... ... / LEACHING LINE No. of Lines Length of k ch .._.. . . �........ g (1 ---- ..__.� .--------- . . 'D' Box ..-. Type Filter MbtefGI -. -Dept Filter Material ..__....__. ---------- _ Distance to nearest: Well _.. --- -- .. :,'.t -- i - Folndian .....1.0--....... 3 Property Line .....--- -----j-: SEEPAGE PIT [ } Depth _ ------- Diameterr.............. Number ........... Rock Filled Yes 0 No (:3 Water Table Depth ' .►.............. --- ----I-Rock Size .._.._....___._:.. i Distance to nearest: Well .._- .-------------•-....__ :Foundation ........... ........ Prop. Line ---_.-----...._.-r,-. REPAIR/ADDITION(Prev. Sanitation Permit# -------- ------ - .. - Date --- _----•------- Septic Tank (Specify Requirements) ..---. ...... ...............A ---- f - ' Disposal Field (Specify Requirements} --•--I ......:.: ... .. . ..•_._.. ---..... ....................... ............ 7_-:��, _777-i-+_�-- _ .. . {Draw existing and required addition on(reverse side) f k hereby certify that I have prepared this application and that tke work Lwilil be don* Jn accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Eocal,Health District, Fi6me b,wnWbF licen- sed agents signature certifies the following: ,.- �+ � r performance of the work far which this permit, is issued, I shall'not employ any personn such manner I certify that in the perfor a e ,..� ..�� Z as to become subject to orkM2_,01:17 ' ensation laws of California." �r Signed . .. .. - ----------------------•-------------- Orn r Title ... . .. .... (If other than owner) 4 F DEPARTMENT USE 0 . LY APPLICATION ACCEPTED BY __ ....... __•-• = DATE r DATE . ...--.."`"�'"... ................ BUILDING PERMIT ISSUED -------- --- .. -- ADDITIONAL COMMENTS ...... .... ..... ... ----------------- ---......---------.... ............. ...... ......_....:.., :. ---------- -------------- ----------- ------- --- --------- ---- Vr... .... ..........._--_--- ------------•-- ...-- f -- - ---- - - •Z .......................... ................------ ----'- Q �-C.� .._.,_._-:... Final Inspection b Date .._. :cG _.._..--.I p y: ... :��d�---- to a SAN JOAQUIN LOCAL HEALTH TRICT[ r , 7/72_3"'A