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FOR OFFICE USE: y APPLICATION FOR-SANITATION PERMIT -------------------- ----------------------------------- Permit No: � `i (Complete in Triplicate) ----------------------------- -------- -------- --- This Permit Expires 1 Year From Date Issued bate Issued Application is hereby made to the�San Joaquin Local Health District for a PP Y q 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: G JOB ADDRESS/LOCATION .__� ---©-�- ---------- --- --- ---------- -- - - -h-"�-- -------- CENSUS TRACT -------------------------- Owner's ---- -• ---------------- Owner's Name ------------------ - ------{ -- - - ------- G,=•. Phone .l.w�-.-4.077___-- Address - >D e40-------------- City __ Contractor's Name a -------------License # �� Phone �6A-_-F�Q7.-- i ;r Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court ',❑ Motel ❑ Other -------------------------------------------- ' Number of living units:_-. ;.ii__- Number of bedrooms ---3----Garbage Grinder ---_-_ems L Size . '---------------- Water Supply: Public Systemandname -------------------------------------------------------- ------------ -------= -----Private Character of soil to a depth o!!f 3 feet: Sand'❑ Silt;fl Clay-[-] ❑ Sandy Loam ❑ Clay Loam a] Hardpan ❑Adobe Fill Material _.-- ------- If yes, type _-------------------------- (Plot plan, showing size of lot, location of system in relation to wells, bbilcl ngs, etc. must be placed on reverse side.) NEW INSTALLATION: s6`p_t + - �{N.o�-septic tank or seepage pit permitted if public sewer is available within 200 feet,) � h. PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size-------------------------`---------------------- Liquid Depth ---------.-----_-----._-_-- Capacity --------- Type -------------------- Material---------------------- No. Compartments ...................... O Distance'to nearest: Well --.----------------------------------Foundation -------------- '- Prop. Line ................. LEACHING LINE [�] N6.,!of Lines ------------------------ Length of each linyy��e--------.----�-."`'----C Total Length -----------.---------------- W- a.,,-4i `tib;s7 "`� :a- F I h D' Box ------------ Type Filter Material%-----------------UDepth Filter Material ----------- ---_---..-.----__---.----------- Di ai. lnce to nearest: Well ------------------------ Fo ridafion"�---------.--------- Property. Line ------------------•----• SEEPAGE PIT [ ] Depth -------------------- Diameter --------- 'Number ----------------------------_-______- Rock Filled Yes ❑ No i❑ Wat Table Depth -:----- .Rock Size , Distance to nearest: Well -------------- ----j_--,:--y......Foundation ----------- -------- Prop. ---------------------- iM REPAIR/ADDITION(Prev. Sanitation Permit s# -------_--------------------- ---------- Date --------------•..-_---.----- ro Septic Tank (Specify Requirements) ------------------------------ ----- }------•-------- -------------------1 19 Disposal Field (Specify Requirements) ------ _--------------------------------------------------r-" ------------------------------------ ---------------------------- ---- -I�- ------ d4L,,-- ------------------------------------------------------------------ I ------------------------------- -- --------- ------ -- I. ( (Draw existing and required addition on reverse side) I hereby certify that I have preparedthis 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.Focal Health District. Home owner or licen- sed agents signature certifies the following: } "I certify that in the performdnce of the-work-for--which this-permit-is-issued;l--shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ------------------ Owner lJVtct I BY --------------- �` ---- ---------------- ---------------- Title '-- ,�1 (If otherowner) FOR DEPARTMENT USE ONLY 4 APPLICATION ACCEPTEDY- -f ---------------------------------• DATE z-- ------ BUILDING ---BUILDING PERMIT ISSUED ----i)----------------------------------- --------------- `-------------------------------------------------- - -- t 3 ---------DATE ------------------------- ADDITIONAL COMMENTS ----'�------ ---- I l - ------------------------------------- --- =---------------------------------------------------------------------•---- ---------------- -----------------------------i�--------------------- - // -------------------------------------------------------------------------------------- ----)z Final Inspection b -- -__- -_ -- =--- - ---------- P Y Q2 Da# SAN JOAQUI ' LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M