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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT r ' '.................'r.-....:....�_...... Permit No. .24'.-X11 (Complete in Triplicate) ...................... This Permit Expires I Year From Date Issued Date Issued .. ..- 1 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: el JOB ADDRESS/LOCATION ....... .1 . _f...- 6—, ......... ................------- ---- ----CENSUS TRACT .......................... :. _ Owner's Name �A .Z .. ....C� ho . 77 Address ............: ------ City '�.A...... Contractor's Name ... / r..�i,...f=vl Fi ------ -_------------------------- .License # .�.ff��5 ... Phone .C)3-9.�1� Installation will server Residence U Apartment House❑ Commercial (-]Trailer Court :❑ .� __..� ...� . ,.Motel.❑-Other.�.:.:._:..::-.:__.._._;-<-..•----=..............-��-.�.�._ A ( Number of living units:.. ... Number of bedrooms _Q------- Grinder. ..._-..-... Lot Size ....... ...... ......................... Water Supply:, Public System and name .... ............ _---------- --•-• -------!. ......................Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loamy Clay Loam Fj { rHardpan ❑ 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.) 1 NEW INSTALLATION: (No septic flank or seepage pit permitted if public sewer is available within 200 feet, PACKAGE TREATMENT [ I SEPTIC TANK t ] Size._............................................. Liquid Depth ....--.--_------._-------- r Capacity .. _ Type -------------------- Material...,..--..._.......... No. Compartments ------..............- � Distance to nearest: Well . -•--------- ---------•-•-....-.---Foundation ....................-.- Prop. Line __................... \ LEACHING LINE [ ] No. of Lines Length of each line Total Length .....---- _. 'D' Box ..... Type Filter Material ..----- •-----....Depth Filter Material -•.- --------.--.--•------•-------------- Distance to nearest: Well*:�r:._.=t.........:..... Foundat4on �:: .:...: Property Line ---------------.. SEEPAGE PIT [ Depth ........... Di meter' ------------- Number #............___....., Rock Filled Yes ❑ No i js ; 1 ...Rock-Size -------------- Water Table Depth REPAIR/ADDITION(Prev. Sanitation Permit�# .................................`....v ----�`._0.Date ----.-------...-_.-_---_ ... Prop. tine ...._.. ........ Distance to nearest: Well .......................... --.....Foundation -._.____-- Septic Tank:(Specify Requirements ¢ n _ _ Disposal Field (Specify Re uirexmentsL__- .-_ -=. - t . _ L 1 - li_. -' i. .--------.............. -..........-- - --- ----- .-------------- --..:................ .. - (Drdw existing and requu_i�ed addition on reverse side),) , I hereby certify that I have prepared this application and th-cirt—he 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, I shall not employ any person in such manner as to become suble to Workman's Compensation laws fof'Ca tifornia." Signed .. �. -°� E iEOwne�. - -- By .... . ... ....................... :_._! ...... Title . ._ . r ....--- (If other than owner} f a *- FOR DEP ARTMENt USE ONLY APPLICATION 'ACCEPTED BY -- -.. - . . ..... ._.- _..-•. DATE .--.-3:.��7 ................ BUILDING-PERMIT ISSUED-! .. �--•- .. .... . ... ...-- -. . ---F -��,..-- ...--DATE. .::�....--- ............... ADDITIONAL COMMENTS _—.---------------- = - - :......................... �. .................._............__. -" - Final..inal_-_......-_ i__._.._y:_._. -- ........................................................`_._..._..._..._._ .-...___......... ._. _ �, Inspection by: ..... ...Date •---•___-- t y ,SAN JOAQUIN LOCAL HEALTH DISTRICT F_14.1.3 241_'AR &P„ qAA 7 171 1 u I