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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT „ s 1. 'Permit No. (Complete in Triplicate) _ ............--------------.......- -- ........ _ ,. . ... . . _ �... .. _ Date Issued ..rr .7..7.. This Permit Expires t Ysar.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 made in compliance with County Ordinance:No. 549 and existing Rules and Regulations: i JOB ADDRESS/LOCATION j a' / �-� _ /_ " , ...f?`..►/f✓ , T w _ M E CENSUS TRACT .......................... .._ r _ • w I ' Owner's Name ...................:.........'.....:: ..............................c��,� vt hone .,�- .. .., .......................... .:...........__. 1 Address .<_ ._.:.r!Q.L:otic ...-.. 1 r.._...SJ.. .. .................. ...........:.......... ty . Contractor's Nome ".!".i.` -�J .........:: ............. ...License,# YJ...... Phone ...................... - .4..._._....- Installation will serve: Residence[TdApartme House{] Commercial OTraller Court C3 Motel'❑C er._.7.......... Number of living units:...t.--__ Number of bedrooms .-_ . .Garbage Grinder ........I... tot Size ...:_. ........ ••-•••......••. 0 -` �M� ;l�if;:�` � ................Private ❑ O Water Supply: Public System and name .....:.../ ¢F'�i�SLG° ... G` ... ._....................:.".. Character of soil to•a-depth of-346t- Sand❑ Silt❑ Ciay 'Peat❑ Sandy Loomi❑.'Clay Loam ❑ ,-� +Hardpan Q , Adobe�ill.Moterlal _ !f yes,type . : ..:...... .. t. Y �i. if ..�� - (Plot pian, showing size of lot, location of system"Iin"relation`to wells,buildings; etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer.is available.within 200 feet,) , PACKAGE,TREATMENT, [•�].� SEPTIC TANK I ] Size................................................•.Liquid Depth ......................... CapacityType ...... Material.............:........ No...Compartments ...................... ...Foundation - ... Prop. Line Distance.to nearest: Well ......--- .......... ........ LEACHING LINE [ ] No. of Lines - ----------- ------- Length of each line..........................�Total Length ............................ '©' Box ....:::._... Type Filter Material ....................Qepth Filter Material .... kDistance to nearest: Well ....-----------......:.. Foundation Property Line ..............----...... ` SEEPAGE.PIT • [ 3 Depth '...._'._.._�,..__-- Diameter ..... :._.: _ _ __ •' Rock Filled Yes ❑ No ❑ t Number° R m� Water. Table Repth Y ;. .. . u . Rock Size ................................ Distance.to�neset: Wel) .._..... Prop Llne • ....... .. . .--- . � i - ....................... . R9PAIR/AQ TION(Prev. Sanitation Permit ...............I...............-L.... Date ................................... ). Septic Tank (Specify Requirements) _. Disposal Field 15pecify Requirements) �� '' /�►. ----•--- P ' ...------ --••--- ............ - -••-•-• ------------ ---•----•------------•-- ----------------- ----------- (Draw existing a required addition on reverse side) I ':hereby certify that I have prepared this application and that the work will bedone done In 'accordance With San Joaquin i County Ordinances, State Laws, and Rules and Regulations of the Son 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 manna as to become subject to Workman's Compensation laws of California." Signed ------- --- -----------------------•-------- --- -------.. ............ :...__..._._ Owner i Yitle r.x. !�. ;�o w By - (if other than owner( FOR DEPARTMENT USE ONLY DATE �.-. 7--_7.7.. APPLICATION ACCEPTED BY - ------- ........ -- -. ---.--- - ---•:. -. . __.. - w �- l ------------ BUILDING PERMIT ISSUED '..- . ' ---.._..... .--•...... .....-•----... DATE ..._.. ' ADDITIONALCOMMENTS ------------ ••.._..------------- ----------=------------•-•---..----------------••-...---------...__.-------------------------------------------------------- --L :-----••--- • ------------ --------- ---•- --- --- -•---.----------- --- ------- .............•-••--•.-•--• / 4 / Final Inspection by: -.j..._ / . ... ......................._�.............:.. gate .. ..r.. . `.. ._ .. ........----- EH 13 24 1-68 /Ikv. 5M SAN JOA UIN LOCAL HEALTH DiSTRICT $/7& 3M