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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ........... .. ....................•--•- (Complete in Triplicate) Permit No: ..77.-..._...... .......................................... G r,F-75! This Permit Expires 1 Year From Date Issued Date Issued .................... GZS`/ -2-10-5:3 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: r / JOB ADDRESSAOCATIONCaNS&e�AK —.... .:.........::..... } Owner's Name .... � ..._ ., �l[N ---------- - ---- T,...._..0 _. ..__..........Phone ,ci .._. Address ....................( .f ie._.. �1 1 �'r City r r✓-•`'..................... ..--....-................ Contractor's Name ................0�;-P-W.--------------- --------I...........................License # --------- ------ Phone ............................ ... Installation will serve: Residence 0 Apartment House❑ Commercial Trailer Court 0 Motel Other Number.of living units:....... .... Number of bedrooms ._...Garbage Grinder .._.....___. Lot Size .�� ....... ....... Water Supply: Public System and name ---...................................-------•-•---..--....:..............._....--------------•---.............Private Character of soil to a depth of 3 feet: Sand'' .-Silt 0 Clay ❑ Peat E]_ Sandy.Loam ❑ Clay Loam ❑ T 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 on reverse side.) NEW INSTALLATION: (No septic tank or ee ge pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT SEPTIC t - - - Size_ Liquid Depth ..� . . .. �pZ Capacity Type - 1Material...�P=i _ No: Compartments .......... Distance to nearest: Well -__ ,. 7f- _!� _---.._.Foundation --- _____ _ Prop. Line .......... ..... . LEACHING LINE No. of Lines . 1�___.... Length of each li .-_._._.--t ........_. Total Length D' Box ..... .... Type Filter Material� r� epth Filter ate ....I 5—q� d Distance to nearest: Well . --__. Four ati _ ---------- Property Line SEEPAGE PIT [,c) Depth ...........:........ Diameter ----------_..... Number ..._......._......_.._...... Rack Filled Yes ❑- No Q i. Water Table Depth -----•------•-- ----•--••......:.:..............Rock Size -................................ . Distance to nearest: Well .................................... ....Foundation .......... p. line._..................... . .__..... . Pro REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .................................. SepticTank (Specify Requirements) ---------------•---------•••-----------------•----•-------- ........................................... ..............-...---•••--••-••........ Disposal Field (Specify Requirements) --------------•------------- ........ ------------------------------------------------------------I........... -•--...- -------------- ---------------------I........ — --------------------------------------------- -------------------------------•--...................--•--•------------------------------------ . ...............--- .................-...........__._.... .........................•................................ ............................................................................................................--................................. ........................... ........................... (Draw existing and required addition on reverse side) I hereby certify that Vhave 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 licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workma 's.Compensation laws of California." Signed -X-- � --•--- ................................. Owner By ...............................................................•--------------------------------------. .Title ....: -------------• ---_._ .. ......------------------------------ (if . --(if other than owner) FOR DEPARTMENT USE ONLY I 1-7- APPLICATION ACCEPTED BY .... �.:..... -- •------._ ............................. DATE ...�. ......... ..._ ........:.... BUILDING PERMIT ISSUED .... .:DATE ADDITIONAL COMMENTS ..... _ 7 .....f. . � '. �i+a+G-- �r � "aGr!�`� ...................•-------...... --------------------------- { -----• ..z '. - ._._. .................................................. --._....._........._......................-----------------.-•----............... ... Final Inspection by: ...................:. .li:'�....:............_._.......... ... Date .........�.� . SAN JOAQUIN LOCAL HEALTH DISTRICT (�¢ 0 L, 1-1 24 , .Ln n_._ C.. 7172-J--,q'