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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Z [Complete in Triplicate} Permit No. _�_�-_-5------- - ----------- ----------- ---------- ---------------- - �""'�-- This P Date Issued ..Jr7.2- Expires 1 Year From Date Issued ----"7 Z i n is hereby, made to the San Joaquin local Health District for a permit to construct and install the work herein 8 described T is ica i n is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: 0B 5 �r-a•�� ATIN _ r CJ�G !r' � f 011, -- P-? ------- ---�s�-.-�� ,- --------CENSUS TRACT 53�---- i Owner's Name --_ L L �'_--:-----1.�9-- ----� � ----- ----------------------- --------Phone -�-- - -------------•-------- Address -------- ------ �� P ---------- City _�� 4 � / r�� -� f/ Contractor's Name __-_ --------------------._ --------License #'�Z.V 57_ '- Phone :- Installation will serve: Residence partment House❑ Commercial:❑Trailer Court ',❑ ' Mofel ❑Other ,r ,� Number of living un,ts:_------ _ Number of droom/s� ___ ______-_Garb❑ a Grinder _,-Lot Size Water Supply: Public System and name _.___ _- _-I1-1`t___Gfler Private ------------------- ElCharacter of soil to a depth of 3 feet: SandE] Silt:❑ Clay Peat❑ Sandy Loam ❑ Clay Loam:❑ t Hardpan ❑ Adobe Er Fill Materia!/ If yes, t (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) i a: NEW INSTALLATION: (No se 0c tank or seepage pit permitted�if:public�,sewer is available within 200 feet,( PACKAGE TREATMENT A ( ] SEPTIC ANK�[ • e" ,' y�>✓�� t Liquid Depth 1 I Capa {_- -------- -- Type Material�,&►enNo. Compartments ............ Distance N } Distance tnearest: Well _-__Foundation --_�Ilkotcl !� _- -____ Prop. Line/___ [ No. �f �inoes ' - - ----�•---�- LEACHING LINE _ _ Length of each` _line--_ _ Length D' Box - _ Type Filter Material 91---47 ----Depth Filter Material J� i � Distance o nearest. Well ------ ___-- - Foundation __ __0-----.-____ Property Line SEEPAGE PIT �r� p � r� ' [ Depth _ Diameter ( --��------- ��-�-_-- _ Number ._- - ---------------- Rock Filled Yes No :i❑ Water Table Depth ` Rock Size �Z-_X ----------- r to nearest: Well ___�___'=r'"�---------------Foundation ___�G� ---_____ Prop. Line . - ---------REPAIR/ADDITION(Prev. Sanitation Permit# ------------ _----- --------- -- -- Date --------------------- ----1 Septic Tank (Specify Requirements) - - ------------------------------------------------- Disposal Field (Specify Requirements).`,_:_________ . < P _ -____}------------------------------------------ -�y ___________________________ __._._ __ 1 _ �`. i (brave existing and required ad I herebycertify that I have prepared this 'application and that the - - -^ i addition on reverse side] p p Pp a 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 shal�npf employ any person in such manner as to become subject to Workman's-Compensation laws of California." �; Signed Owner: ' t �,�•ci3 By ----- Title -- - ---- - -- --= - (If other t owner) 5 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY BUILDING PERMIT ISSUED _-- _-- - ------------- ----; DATE ------6._02 7'_ WL - - -<� DATE 1 -------------- = _ ' = ---------- ADDITIONAL COMMENTS -------------------------- O, ---------------------------- - -------- --------- ------ ------------------------ ---------------- _______________________________________________________________________________________________________________'____._i.____£_.____,._______._____ _-_ __---___ __ ______________________ __ ____ -+ Final Inspection by: _____ ,,� __.-___.. --- - ------- ---------------------------------------------.Date ---(�',l _ • SAN JOAQUIN LOCAL: HEALTH DISTRICT ; E. H. 9 1-'6$ Rev. 5M _. 5