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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT _- -- -------- --- = a a `Y _ Permit No- -------- / .. 7 � � (Complete in Triplicate) - - '- " /// ., p Date Issue&-X �f 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/LOCATION R ----- SGS------- -------- CENSUS TRACT - j Owner's Name - _le x cell ,�-1r a- LW -,-----Phone. ---------- Owner's Name - 1 . - City �QllG.r, f Contractor's Name --------- -� ------ ,0ice- --------------------------•-=-------.License # / .J =s��Phone - _y Installation will serve: I Residence partment House 0 Commercial ❑Trailer Court I Motel ❑Other ------------------------------------------- _-Garbage Grinder _ _ _ Lo Size - _ X '-------- Number of living units:---- Number of bedroo ___� fir'---- � /i pQ Private ❑ 4 Water Supply: Public 5ysfie� and name .�ll�--�-(-- ----. -h� - - - '�"�........................- Character of soil to a depth of 3 feet: Sand'❑a—Silt-0:f ay-�®�eat+I ondy Lc I [] Clay Loam ❑ Hardpan Ad�'❑ ill ferial -_-- -_ If es, e ....-- ___-- Y t k (Plot plan, showing size o lot, location of system in relation to wells,'-uil ings, etc. ust be placed on reverse side.) NEW INSTALLATION: (N septic tank or seep ge pit permitted if public ewer is availai�le within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size------------------- -- -------------l -- --- Liquid Depth ------------- W - o. Compartments ______._.___ Ca,P Y --------------------- lypeI Distance to nearest Well ------------------------------------Foun tion -•___-- Prop. Line ----------=---------- -- - LEACHING LINE [ ] NO. of Lines -.__----- _ ____.-- Length of each (i L .... ---- Total Length 'D' Box _--- ------- Type Filter&terial ------------- - C7ep h Filter aterial _.___-______ ._ --------------•-------•--•- Distance to nearest: Well•-- --------------- Foundation - ------ -- ------ Property Line -------- ------ SEEPAGE PIT [ ] ,Depth -------------------- Qigqarji�et�r------------�Number --- - --- --- ---------- Rock Filled Yes C3 No 0W ter Table Depth F - �- ---a''--•-------- a k � � isfance to nearest: W ------------tFou dation -------------------- Prap. Line ---.-------. --------- REPAIR/ADDITION(Pre/S nitation Permit# _____- -.--- --- -- - t . -- ---------------------------" ) Septic Tank (Specify Requirements) - '" _ ..r�-- " -'----------,-°- ------ ---------,•----------------- - -------- Disposal Field (Specify Requirements) ..._g Atlii� � ------------------------ Q. ------------------ - --- i - - - ---------- - ----------- --- t--------- ' ( raw existingand required oadition on reverse side) ; I hereby certify that I have preparedithis application and thhat theAwork will be None in accordance with San Joaquin County Ordinances, State caws, and Rules and Regulations of the San Joaquin Local Health District. Home owner orilicen- sed agents signature certifi4s the foliovring: N%1K "I certify that in the performance of t e work for which this permit is.issued, l shall not employ any person in such manner as to becomes to W n' Campensation laws of California." Signed _.- --- O,w,ner,�� rd 1 j BTitle ----- '1�-�= ----------------------------•-- Y --------- ------ (If other owner) FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTEDY __.__. -_ --------------------- DATE ._3." 1/=6�F --------- PERMIT ISSUE - ----------------------------- -----DATE =------------------------------------- BUILDING ADDITIONAL COMMENTS-s"2r __ f'� `7�� ` ----- -------- -------- - ------ ----- ----- ---------- v� -1- -- _� _ - --_. ,�- ------- ------- ---- --- -- ---- --- Final Ins ection b -------------Date ----- - --� ----- �,_ SAN JOAQUIN LOCA_ L HEALTH DISTRICT,-,-,,,_ E. H. 9 1-'b8 Rev, 5M•