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FOR OFFICE USE: -- APPLICATION FOR SANITATION PERMIT a�mit r (Complete in Triplicate) P •- ••.•--'.�:.3.� t .. . .......--------....................•............... Tkls PermItExpires t Your'from=DaNlssued Date issued Application is hereby made to the San Joaquin Loe6l Health District for a permit to construct and Install the work herein described. This application is made in compliance with County Ordinance No. 54�d existing Rules and Regulations: JOB ADDRESS/LOCATIONjJ .a.. .., G � •...�l� .S'_........J2-?-e ..................CENSUS TRACT .......................... Owner's Name .. ... ......_ ... ..:.... ..... ��. • •--.......Phone .............. Address ......... . .L'. .• .._.......... .. .. ...-� _ ......'City ..�r�r.'�� Contractor's Name �� :.f.....License# phone .................. i....................... Pone Installation will serve: Residence Apartment House fl Commercial ]Trailer Court 0 Motel € ' ❑Other ... ............._--•- Number of living units:.--_-_.:'..-_ Number of bedrooms _ ...::....Garbage Grinder l/_ar�.�.. .Lot Water Supply: Public blit System and name...:................ . - Character of soil to a depth'of 3 feet: Sand E] '.Silt p Clay p peat❑ Sandy loam t7 Clay Loam Hardpan 0 Adobe•fl Fill Material ........ ... if yes type...................... (Piot"pian, showing size of lot, location of system in reiOrion to wells, buildings, etc, must be placed on reverse aide.) NEW INSTALLATION: (No septic tank or seepage pit per-mitred if public sewer is available within 2Qt3le J ,fee PACKAGE TREATMENT ' C ] SEPTIC TANK `""' r tSizeS4. -. .?f__.a�� - Liquid Depth Capacity -- Type�?,C.i � Material No.No. Compartmentsdo -- / " � ................c..I ' Distance to nearest: Well I /� ° � ld�t c!................ Foundation . i� .. Prop. Line —X.e.......... t ..... LEACHING LINE No. of Lines ....- ° - � l . ..----•--=.. leng#h of each line-._.��..__.. Total Length 1....��.........._.�� n 'D' Box�l .�.. Type Filter Material/..:d c� Depth Filter Material /� ..........-- ••--••� Distance to nearest: Well ..e ........ Foundation ......... Property Line ...c1`..'. FIT Depth ...-f _�. -- 11-- Diameter _ _ - Number -------------•--•----------, Rock Filled Yes,�l Water Table Depth .�''` F �� -Rock Sized _ ---i f Distance to nearest: ......................Foundation-:�fi�-. Prop! line REPAIR/ADDITION(Prev. Sanitation Permit _ Date Septic Tank (Specify Requirements)...........---------•................ U . .......-----•-----...---•-•-----•-•..............a............. Disposal Field {Specify Requirements) .__ ...... - =-••--•---------------- ------- ..... ............. ................................... ........... -------------•-----•------ - ."- ' r ------------•--•--•-------------•.....-•--•..............•-.....:.... = (Draw existing and required addition on reverse side) I hereby certify that. 1--h-ave 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 Nealth: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, I shall not employ any person in such manner as to become subject to Workman's Compensation taw:'of California." i Signed -----------------•--•-- --- ----- - Owner '" B r ,t Y .. - - �e----------------- Title - `................ • {ff ath t n owned- - - - - - � --------------• ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------------------------------------------- DATE . ... .-Jif� f BUILDING PERMIT ISSUED .............. -------------- ` ^ '=�: DATE _.------------------------ ADDITIONAL COMMENTS ..-...-.. --•------------- ------------------------••-......_-..--------..------.- ................_-.--.......................................... ------. ••-•........................ ------ ----------------------------- ................. .....--- _..._-.. Final Ins ection b "; '• ,a + v U P Y .-----------•-- : ... Date ....;l /�S.... .--........ ER 13 2 1-&� �• SAN JOAQUIN LOCAL HEALTH DISTRICT � 8/7h 3M