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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT L. ._.... ._._;: ..-... mit No. Per SO (Complete in Triplicate) ................ ....................... _. 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 mode i com Iia ce with County Ordinance No. 5:49 and existing Rules and Regulations: JOB ADDRESS%LOCATION„.... ........ . _._.. .^ . .. .l. ��'� ....,. C ACT ....,..,............. .CENSUS TR .::.. Owner's Name.. : . - .............Phone ......,.. .......................... 0 �. / Address . . ..1-- _. .. ...... �Q..�o.- .. ..._..... :.....^'` City ..,..... Contractor's Name ---- 71vne� 4 - � ----•License #x`r ' l[ .Zz. Phone ...-. Installation will serve: Residence❑Apartment House❑ Commercial❑Trailer Court 0 — .. Motel ❑Other .._.....................--------------..... -Number of living units:__.__1..... Number of bedrooms _._.,rt____Garbage Grinder ............ Lot Size vix-10......... Water Supply: Public System and name ""' ,. ,��,�— �- � - ............Private ❑ L" PP Y ................ Character of soil to a depth of 3 feet: Sand❑ Silt 0 Clay ❑ Pea,t❑ Sandy Loam 0 Clay Loam ` Hardpan [) Adobe'❑ Fill Material "........... If yes,type ............... ............ (Plot plan, showing size of lot, location of system in .relation to wells,'_buildings, etc. must be placed an reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,' i PACKAGE TREATMENT [ } SEPTIC TANK } __ : .';T_ ..- Liquid Depth .. ..k .............d t • capacity I � _ .. Typed Material.. No. Compartments .... .... Distance to nearest: Well ____ ...............:...}...Foundation ..... :. __ ��_ Prop. Line ,��.�.......�. g � LEACHING LINE [ ] No. of lines ..__. _--._-.-.__ Length of each"line:..... . ._ Total Len th170 'D' Sox ._./...... Type Filter Material ....................Depth Fitter Material . ............_.................... r, � Distance to nearest: Well ........................ Foundation ............... Property Line ........................ SEEPAGE PIT [ ] Depth " ._ - (�Diameter ................ Number .....6.�........,,......:.. Rock Filled Yes„ No C). .. w Water Table Depth -............-----..............................Rock Size ................................ O Distance to nearest: Well ..._..___..............................Foundation ._...- '--•'_.._..-' Prop. Line ...................... 7 f REPAIR/ADDITION'(Prev. Sanitation Permit# ..........-................................__ Date _..___.. .................... Septic Tank (Spetify .Requirements]-__-:------------- -------- ---•---------------,.,.--.................................. ....................................... Disposal Field (Specify Requirements) ----------------••-•---------------.-------__.__-.---------•---•------------------------ ............................ _- --- 4------•-------- s= y :. -------------------------------------- -------• - _ - - .................................... (Draw•existing and required.addition-on-reverse-side) ',.,• 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 San Joaquin Local: Health,District. Horne owner or Ilcen- sed agents signatu;re'certifies the followings` N 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 to.Workman's Compensation laws of California." Signed, r' - --- ------ ----- -------- -- --• -- ,,, Q _ caner BY --------- - ----= -� -- - ----- L ._-.. Title _ -- .......... .... .. ( f he than. er�} � � __.FOR-DE AllTMENT USE- ONLY APPLICATION_ ACCEPTEa BY F' :..-- -- - n----_---�="--------------------=--------------------------.•DATE,.:....,:._. �_o. ..7�...._.....--'- F BUILDING-`PERMIT ISSUED"-----''------ - _ µ ------ " - :_.:DATE ...._..:__...-_._.. _. ADDITIONALCOMMENTS _------------- ------ ---•-- ----------------- - -------------------------- ---------------- -----------------_-------•------------_-- -- ' ----------- - --------------------------------- _ ._....._.- ... --------- ......_..---•..._.._.. ..... .. ........ ....... -------------•--------•-•-------•----•-----•••......_..... ._ ._... -------------------"••---- Final Inspection by: --------------•_....... � .. . :^tea 6...---.....__...-- _........--•----- .....Date V. _� EH 13 2 ' Rev. 5MSAN JdAQUIN LOCAL HEALTH DISTRICT 8/7h 3M l�