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'` y F R OFFICE LJ5E V APPLICATION FOR SANITATION PERMIT Permit No: .. (Complete In Triplicate) i ....................................................... ........................:....................:.:......... This Permit Expires 1 Year Frans Date issued Date Issued ... Application is hereby made to the San Joaquin Local Health District for a permit to construct and Install the ', rk'herein described. This application is made in compliance w' County Ordinppce No. 49 and existing Rules and Regulations: r JOB ADDRESS/LOCATION ., ?q. ---N..._.._..• __ _..Q•...CENSUS TRACT .:...................' . . . , _ Owners Na!VA ...........�-:�_� �. . . . _ ..........�.. ......................................Phone�._.... ....._.. Address, -!?zC�'. ..... Q.€�? f....®:_r=. Com. fef•.. City �j� _..License # ........................ Phane //-``------//-- Contractor's Name .�Lt.�t� � A-��,..�... �®`',&� __...- Installation will serve: Residence Apartment House 0 Commercial OTrailer Court 0 f Motel 0 Other...........: ................................ / Number of living units:-..t Number of bedrooms Garbage Grinder Lot Size ......... Water Supply: Public System and name .....:...............................................................:............_..._........................Private Character of sol I to a depth of 3 feet: Sand 0 Silt 0 Clay 0 Peat.0 Sandy Loam 0 Clay Loom,` ` Hardpan 0 Adobe Fill Material ............ If yes,type...................... {Plot pian, showing size of lot, location of system in relation to wells, buildings, etc.'must be placed on reverse side.) y NEW INSTALLATION:. (No septic tank or seepage .pit permitted If public sewer is available within 200 feet,) ` d `f IN PACKAGE TREATMENT [ ] SEPTIC TANKA, ze.:...�.�? .. f.r:.....:........... Liquid Depth P � . ......... Capacity ....... Type 11a..... Materia!_ No. Compartments Distance to nearest: Well _.�,`,&-.......................:.Foundation ....��......... Prop. Line ....001, �'��......... 7`-0- - --- ... Total Len th �r�r.�.:�....:...� k LEACHING LINE � No, of Lines .�.... a......... Length of each line___... _... .rf Type Fiiter Material ._ ... p •.._ D' i3ox De tfi Filter Material Distance to nearest: Well�� _.._._.__ ___ Fou-dation ..._..� �......_. Property Eine ._....etc............. ..:. SEEPAGE PIT Depth ... . Diameter �.�p.. Number .._.. -. . Rock Filed Yes Ig No I� p Rock Size � .? .3.5�y Water Table Depth -•--------•-_._..__j.............. --- ----• .... Distance to nearest: Well __-.:�._ ©....................Foundation SP.S'.. Prop. Llne ..��Z..,..-:-....... _ REPAIR/ADDI#ION(Prev. Sanitation Permit .......................................... Date ....I SepticTank (Specify Requirements} ..............:................----------------------------------- ...............--....................................._....i............ Disposal Field (Specify Requirements) _________________:. ........... ... .....---------•------•••--...-------•-••--•-------------.. ................... i ...................................................... ................... .... ...._....... ..»._... _ I ------------------'---------------- ..._._ ............................................. ......... .. .........••---_----' -----------._____-----•-----........I... ............- (Draw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will be clone In accordance with San Joaquin County Ordinances, State laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or liven- f sed agents signature certifies the following: "I certify that in the pe ante of the work for-which this permit is Issued, I shall not employ any person in such mann as to becoma sub' t t W kman's Compen tion laws o alifornia." Signed _ :. �... .... - .-_-- ------------ By . Title _... ........ ........."'._........... ......... (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ... : . _. . .---._........ .............................. DATE .. _� _' tet""................ BUILDING PERMIT ISSUED-_!...........................................................:.......:-.•----• --•-- .......=..............DATE ------------- ...._.... .................. ADDITIONAL COMMENTS ... .............. ..................................................../... . . .. ...................._................................................................:.......................................... ...................................../; r......... ..._..... ........................................................................a .__...�_:.a.�s..1.................... ...._Date .Final inspection b �a.�'.:: .......:.......... e f �` > SAN JOAQUIN LOCAL HEALTH DISTRICT 9-u-I3 24 -=u* o__._ &A. - ---