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' FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT LL11_ ' .............................. ..... �.iComplete in Triplicate) ; ............... Permit No. .. . .. ........................ ................................. - qJ�16 / r/y Date Issued .................... q .......... This Permit Expires 1 Year From Date 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: JOB ADDRESS/LOC TI N .----./� ��--•- / C' --.. . . -....CENSUS TRACT ..............:........... Owner's Name .. . . - . ------------------------- ....................... ----• -_ .. Phone .................................... �-.�,� .. Address ......... .. tl h'h -------- --•._. Cit /....---- ..................... Contractor's Name ...... . Ate,-<.. aJ F"- `. "`- ..License # � 87J y Phone Installation will serve: Residence [Apartment House❑ Commercial []Trailer Court ,❑ i Motel❑Other ....-• ............................. Number of living units:_. ....... Number of bedrooms ......Garbage Grinder ............ Lot Size ---............................... /...._.. Water Supply: Public System and name ........ ---------......•--------••=--....y.....------------------------..... Private [J Character of soil to a depth of 3 feet: Sand Silt Cia y Peat Sand Loam �la Loam P �❑ ❑ Y�❑ ❑ Y Y ❑ 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 or seepage pit permitted if p bli sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK-T ) Size. ...-.. S Liquid Depth .- .-.......- -•-- i . . � ..- cat Capacity.P?ebq. .... Typ �.-_--Ma erial.. .... No. Compartments ......... Distance to nearest: Well ...._--- ---.. ..•.Foundation _IZ9.. ....... Prop. Line .......... I LEACHING LINE No. of Lines Length of each line Total Length .. .Q.a. 'D' Box -------- Type Filter Material .23 -------Depth Filter Material .................. to nearest: Well •..`......... Foundation .... Property Line ................. [ Depth ........ 13ianastera.� ./45-'."Number ...........j.............. Rack Filled Yes No Water Table Depth -------------174----------....----•------_--Rock Size ------------- i F Distance to nearest: Well ......./0?P- ---------------------Foundation ........... Prop. Line .�:!. .............. REPAIR/ADDITION(Prev. Sanitation Permit# -------- -------------- --------------- Date -------------------------_--.....) Septic Tank (Specify Requirements) ..... ..................... _...----------...._--------------.._...- ---- ...............____-•--------- Disposal Field (Specify Requirements) --------------------------- ---. .................... .._.. ------ ...........•- -•-.................. .... ................. ....... .. . ..... --------- --------------------------..................... ........... ................... -------- (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 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 become subject to Workman's Compensation laws of California." Signed ................ ........ Owner BY ---- --. .............. ............. ...-.. Title . .... ................ ...... ............................ (If other than owner) ! FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .......-- --------- ---------- -------------- ----------------------------------•- DATE ��5�-.7Z......-----..._ BUILDINGPERMIT ISSUED ............... ... ............................................................• •- - --------------DATE ---------- ------------_- ............ ADDITIONALCOMMENTS ...... ......... ....._..- ------------------------- .........-...-...........:................-.•_............................................. ---- -- ------------------------------------------....•. ----.. ........ .........-- ...-----....---•- ..•--........... ------------.__--........ . , ... .......-- ----------------_Date .. ...-... Final Inspection by: ........ P•' ...... SAN JOAQUIN LOCAL HEALTH DISTRICT H 13 24 1_ res Rpv. sm.— -- _�& ..;, - 7172