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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT L/.-/; ........_. !�` Permit No. (Complete in Triplicate) .................................. JJ ................. This Permit Expires 1 Year From Date issued Date Issued ..:I.:..:...:.�y Application is hereby made to the San Joaquin Local Health District for a per 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 ...... ?� ----- `7/�.... GCS .............:1,_._......_...CENSUS TRACT s..._............._._.._ Owner's Name Phone_ t tie. 1 Address ..............................4..=.'-... ........ City -- _....... Contractor's Name . 15 --- ----.License # .�,4AW._. Phone 414._"74*�-...- € Installation will serve: Residence gj Apartment House Commercial []Trailer'Court 4 Motel ❑ Other ......_.__........ ..----••_--------- Number'of living units....../..... Number,of-bedrooms,_._A�....Garbage. Grindern__,......... Lot Size .... .............. - -- -•----------- --------- Water Supply: Public System and name....................•-----...----___-. - ..............---------------Private I Character of soil to a depth of 3 feet: Sand`❑ Silt❑ Cloy ❑ Peat❑ Sandy loam ❑ Clay loam ❑- Hardpan E] Adobe kga Fill Material ........ If yes,type ..............�'::. .. Q (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 public sewer is available within 200.feet,) PACKAGE TREATMENT [ SEPTIC TANK t ] Size....................... Liquid Depth -----.................... . Capacity .. . ....... ...... Type .................. Material..... .._ -- ....... No. Compartments ....................... Distance -to nearest: Well . .. ---------------------Foundation ............. .... __ Prop. Line .....__.._r........... i LEACHING,LINE No. of Lines Length of eacli line ._... �` /.�...r. Total Length ... .'... ....... I 'D' Box ._ -. . _.. Type-Filter Material ........ '- _:_..Depth Filter Material.,-.... .... ............... ! Distance to nearest:WelldQ__� 1> _._...._ Foundation AO_ Property Line ..a .1:.r..._... 9E. PIT De thA7Diameter ; Number.. .___.-'V ,. . Rock..Filied Yes No Water Table Depth .---..._��..........................ef....Rock Size ---.. _'__..-......_..__._,_: r r / v Distance to nearest: Well _...... __._..,, _._........Foundation .. 13.. ..._... Prop. Line ..a�__C�........... i 19-1 REPAIR/ D TIO rev. Sanitation Permit# . ; .......- Date '----------------- ------------- . Disposal Field (Specify Requirements)......��y._��.._.-. --� ...�(�..............._......------`-...... i ------------------------------------------------- _.- - ---- --------- ------ % `d �} -1.. ....._...._..................... A .. ......---- -- - --- ................ ..................... ... --_--------- .._._..... (Draw existing and required addition on reverse side) i 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 Son Joaquin Local Health District. Home owner of [icon. 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 tgworkman's Compensation laws of California." l Signed ...... le ...................I.............................. .-------------------- Owner I BY Title . .... ... ... . .. llf other than owner) D MENT USE ONLY APPLICATION ACCEPTED BX.... --. -------- ............... ---------- DATE _ BUILDING PERMIT ISSUED =f---------- '7DATE --------------- -- - ---- - - ---------- ----•---...-- - --...---------.. -----�--•--...DATE _... -- ---------... .._... ........_....,.. .- ADDITIONAL COMMENTS --.. 1 ( .............................................. ....... ----------------.....................---............................................ ......... ............ ' -------- fT ...r •---- ----- ............... -------'------------------------ ----- ------•-I........ [ Final Inspection b # --------------------------------Date .. � � - . p Y .. ..._._._ N AQUIN LOCAL HEALTH DISTRICT 0 I c Li 13 24 1 rt_.. C.. 7172 3__L14_-