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FOR OFFICE USE: ' APPLICATION FOR SANITATION PERMIT � ....................... .................. C�entto.7 �' (Complete in Triplicate) ........... .................. ..............._... Phis Permit Expires t hear From Date Issued Date Issued : Application is hereby made to the Son 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 LOCATION � a�y_-l. �C7�C�I LC�a1S.__. n........................ .......................... / - _ - ........CENSUS TRACT Owner's Name --•---•- ..-----•......--- Phone _. b •us.. Address ----------------------------------- lA__... .....City �!'L?._._........ ----....... .:<T Contractor's Name .................. .............................................License # ... ............. ---- Phone --------- ....... ------ Installation will serve: Residence❑Apartment House] Commercial MTraller Court C Motel [4 Other-_.fl-015!!-_IlQ-Mj�.................... Number of living units:..... ------ Number of bedrooms ...I.....Garbage Grinder Lot Size ..... ........................... Water Supply: Public System and name --------- t 19- ..............•--._....--•-----------•-•------------ .t_........---......._..................._.._Prima,o Character of soil to a depth of 3 feet: Sand.0 Silt o Clay n Peat o Sandy loam o Clay Loam ❑ . Hardpan Adobe fill Materlal .......A.If yes,type I ............... ............ (Plot pion, 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 seepage pit permittedif-public sewer Is available within 200 feet,) PACKAGE TREATMENT ( } SEPTIC TANK t4 Size..... ........ Liquid Depth ... ��i..:.:...::.__-- Copacitys_1.RD. --- _•___ Type WnL51=---- Mater€aI.CjD.NC9FX... No. Compartments '............... .Foundation -_1_v_____ .. Prop. Line ...70..............S I Distance.to nearest: Wel{ .......:�l�l.........:.......... ______._ LEACHING LINE ( ] VNo.,of` Lines'::.......L.. .......... Length of each line.......9Q............... Total Length ._.�.�-�...............5 D' !"-Type.Filter Material �i 4',. 95....Depth Filter Material .....1....... .............................. Ristance to neo est: Well ... ...... Fouridaflon ....10.............. Property Line _._` Q.f............ . i SEEPAGE PIT ( I Depth .-.---.--_- -` ' Diameter ............... Number ................... ... .... Rock Filled. Yes 0 'No 0 .. . Water Fable Depth .......Rock Size .........:...... ' Distance to ne'rest: Well ........................................Foundation ............:....... Prop Line REPAIR/ADDITION(Prev.Sanitation Perrnit# ............................................ Date .......y Septic Tank (Specify Requirements) ....................-------- = •--•--•---•-•--•-••----•-----•--••---•--•--•-•--•---- ............. ...........:.:.�7 # Disposal Field {Specify Requirements} -----------------------•------------.............. ..-._............... ...... ---•---•--- ........................................=.................... ----------------------- ----------..............•---......... =-- - -- ------------------- ------- ---- (Draw-existing-and.required addition onreverse side) ! hereby certify that ! 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. Nome 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 shaft not employ any person In such manner as to become subjec# o Workm s C mpensation laws of California." Signed .* _7-1._.... --- Owner i By ----- -------------------.-.---------------------------- --------------------- ----------••-•-- Title . --•---------•-- .-..... (if other than owner) FOR DEPA ONLY APPLICATION ACCEPTED„BY.,_...: ................ ...----••---- . ------•-- ----------- - - ----- ------------------DATE -.. -1.� ��=Z �:._.......------.. BUILDING PERMIT 15 Ytb ----•-••------ ----- • - ---------.DATE ........--................................. ADDITIONAL COMMENTS ----------------•---------•-.--...._..-----...---..--.-:.. -----------------------------•-----------------....-----------------------------------------.--------------------------------------------..--•----------------------------------- ---------------------------------------- ..----•-- ---- -------------------- ----------------------------------------- --------•---------- ---------.. ....................................... -..--•-- ... --. �.-...._. 7 Final Inspection b Date - -- ...-. -- ----- ------------- EH 13 2i� 1-6t1 ttev. SAM J AC?UIN LOCAL HEALTH DISTRICT 8�7h 3M }