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FOR OFFIC USE: . �-7 � � � APPLICATION FOR SANITATION PERMIT � o ._ Permit No. .. -..... -- --- :. ..... . -•- °'� - -{S y- II (complete in Triplicate) ...............f.. Date issued .. ... II This Permit Expires 1 Year From Date Issued . Application is hereby made 11 PP 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. 544 and existing Rules and Regulations: y� ..CENSUS TRACT JOB ADDRESS/LOCATION ..:ll j Ow EJ ' ..... ............. ....................Phone s . -. .. ..7. ...... er's Nene ........ • . ...... -,-• .. r� - Address - -------------- - /U......... ...- •• — :.:... ;: .._......- .% �? ------------------- License `f: .-_ Phone Contrac or Name ..................' ... y'•'- �'�� t3r`i, ! Installation will serve: Residence KApartment House❑ Commercial ❑Trailer Court C] ji---• Motel E]Other _. ...---•+y' •-------------•------•- �. --: ._.. Lot Size .....l..e ............ bage Grinder .. I Number of livingunits Number of bedrooms ._- .-- 1. j} .. ------....•-- ...Private ❑ Water.Supply: Public System and name ... ................... O► IIL J-.._.. '� Character-oftsoil to a depth of 3 feet: Sand. ] Silt 0 'Clay ❑ Pkat❑ Sandy Loam fK Clay Loam �3 I� Hard n Material e .......... ..... f T%41 `� N p ❑ Adobe'- Fill Material-•--.._..._ If yes.typ �. � ---._.... -• -- ,�' ."` `Nt be placed on reverse side.) V (Plot plan, showing size ofoli,, locati,(5h of:,'system in relation to.wrens, buildings, etc. mu 1 x . NEW INSTALLATION: [No septic�tarik,or seepage pit permitted pub)i sewe is available within 200 feet,) a._:.:. ,.._ .............. liquid Depth\,�y.............. PACKAGE TREX-T4ENT-\,-[PSEPTIC--TANKY �S a®.-----.o.s--\);\k�Distance No. Com artments ... ,rCapacity ----1Type ----- • • -----•. Material-� p�' .•--•-•.Foundation ---••/•Q---•-_.... Prop. Line,-de to y�earest: Well -------------------------- - F No. of Lines Length of�each line..__...•-------------••••-•_ Total Length ...... O'emw QED VD Box Type Filter Material .l4 ..__Depth Filter Material -Z72 s�..................••j�----• r /0 Distance to nearest: Well ------------ Founds#ion ...._..� .._._. :: Property Line .... ...... ' " �M " � �. ---.. Rock Filled Yes No �] De th Diameter Number ----------- --• SEEPAGE�Ir [ � � p ._.. .. ...---•-- .�................ jIV-SUxt Water Table Depth ------------------•-----•-- ._._.... .Rock Size ,� �' r .. 0 ltd r��0IX, 0 Distance to nearest: Well _ Foundation fes__..__.... Prop. Line .................... \ iM ..... Date •------------------------- REPAIR/ADDITION ) (Prev. Sanitation Permit`# ........ ---- I Septic Tank (Specify Requirements) .......----------------.----•----------•-•--------- - ---•..---- ----•--........-----•------•------- 1. Disposal Field (Specify Requirements) ...---------------------------...........,..---------------------------------- .................... ..................................•-----------•-`...................... ...-.. ..................................................... . (Draw existing;and required addition on reverse side) [ 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. dome owner or liten- 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 parson in such manner as to become subject to Workman's Compensation laws of California." I I Owner Signed ........................... .....•-- -._ ...f.. _ .__.---- .-----•--.......-----•-•--•--:.... I� ..............: By ........... ... .._. ._ 4.._. Title ................. By � {1f oth a i� owners FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED I�BY .... .. - - ........................-.................... BUILDING PERMIT ISSUED .... DATE ............. = ...... ... -•--- ss...... f-�. ADDITIONAL COMMENTS l�/1 ... �!/{ �/+ e9-5 .........:. ................. ............................ ...........••---------- -----••-------....... .................I---...........-- - - . -•--- --• . _._ ::............ .�.s...........--.. _. • - = .. __.... F Date . -- ................. Final Inspection by J SAN JOAQ OCAL HEALTH DISTRICT l` 1.3 24, 7172 3,K � _��Q Qe� Kne - _ ---- _.