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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT c/ Permit No. ,I1 (Complete in Triplicate) ............................. -,)-3-7S `` - ..............�I--•• This Permit Expires f Year From Date Issued Date Issued -.7 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/LOCATIO I,. �. �U.--_` -. . ...: =------- •-T..............-CENSUS TRACT ...---------- ....... ' Owner's Name iM ..Phone ,i . _....._..._. ac ,43.- ►.�.................. 4�.... f .... r 9} Address > .--....._ . -•------- . City _.. . ------------------...License # 3.Y' ---- Phone %4.. �P.7.._.... Contractor's Name ....._..... ..� Installation will serve: Residence yApdrtment House❑ Commercial ❑Trailer Court ❑ r Motel ❑Other ....... ._.. -------- ---------- t" K 16 Number of living units:....;...... Number of bed ooms --- _----Garbage Grinder ........... of Size I[aJ,-X-10................... Water Supply: Public System and name .............. ---••-... ..-.. -- ---------------------------- Character Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Silt❑ CTay-❑ :,Pea#❑ Sandy—Loam Clay Loam Hardpan ❑ Adobe 0 Fill Mbte'rial............. 1f yes,.type ............. (Plot plan, showing size o�f lot, location of system in re'latio i o wells-buil ip rigs, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage it, ermittedf.if public sewer is available within 200 feet,) r pp J? PACKAGE TREATMENT I SEPTIC TAN ize.. ._ -- .I�..� -------- -------- Liquid .Depth ---�._.......-•-.... Ca`pacityf� - Type .. -..._...._-1i ,M}}aterial'��7G�.:-. No: Compartments ...---•............... • Distance to nearest: Well . ..-. .. .:. .-.,-) •-- --•` .--Foundation ,. . -..---...._._ Pro line .. �...........:. `'LEACHING LINE No. of Lines Y_... Lpngthtof each line ...'- _w-. Tota{ Length .�T ............... . ' s D' Box ..,... .... TypeFilter Materia) ._..I]epth Filter Material _.._._�4-i.��........................... axt Distance to nearest:�Well�:.�:�iy;'"'�s-�r'�. --� Foundr�tian ._---G.O---�'.``•-. .... Property ql�� ....-----............... SEEPAGE PIT Depth . . PP ......__.- Diameter . ---- Number — -..... Rock Filled Yes � No C] t - Water Table DepthA-------......------4---.�_:-.,,�.---- - /�-i r---------- - / Distance to nearest: Well -------------- ------ p. _..........._, Foundation 16.-.f._.____ Pro Line _....._ REPAIR/ADDITION(Prev. Sanitation Permit# 'I,---.............. ....�-----...-.__-- Date ----------------- 11 ---------------- Septic Tank (Specify Requirements? ... .. ................-.............................. ------- -----..-... ...... . ................................... Disposal Field (Specify Requirements) -•-------------------------I-- ......- ... . ............................. _.__.. ------ .........---.---•--------- ---•-- (Draw existing and required addition on reverse side( I hereby certify that I havke 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.`Home owner-or iiten- 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 to Workman's Compensation laws of California." rSigned -.. /. ... r .` Ow n e BY it `(ioth anr -- owner} _ F -TIEPARTMENT USE ONLY I APPLICATION A. CEP ED BY ......:_..... .... ----..._-_.--- ....... _ . DATE �.�.__....., BUILDING PERMIT ISSUED'............... .... •.• ._............._._.__.-.-.- .DATE . . -.--.....--.._..._..._._ _...__._....., ADDITIONAL COMMENTS'N.................- ................ ...............................-...... ---------------------------- ° .._._.._ ------ ......--•----�-----•-•-• . . --••--- ._...------- ---------�--- ... y: ........._' -------- ...------•-----..a...- _ Final Inspection b ------------- ----= Date ........ _ .4 ..2L ..._...--. SAN JOAQUIN LOCAL HEALTH DISTRICT II F w 13 241_'ba Rev. 5M'I _ 7J.- 3 �� ;..