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FOR OFFICE USE: - FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No1 �.:a... . . Date Issued._ •" """"- ."f`_..i.',:.-. - - This Permit Expires 1 Year From Date Issued L� _ Application is hereby made to the San Joaquin Loco! Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance N�. 544 and existing Rules and Regulations: JOB ADDRESS/LOCATION... . - -. _ , _ - .t.............. _ TRACT........... Owner's Name - 6_14 E --- . ----- -- Phone........... Address � fl _ _Zi 1 . _ _ City----------- -- - -------- p ........... Contractor's Name....f ..-f� G -yt,CL� License #,�} '_ �F._l. Phone -c_� - 4qq ii 6 f Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑) Trailer Court ❑ Motel ❑ Other Number of living units; _ f._ ......Number of bedrooms _I.. . Garbage Grinder----------..Lot Size...Jlke A 34Z1.1-.., Water Supply; Public System and name__ .. - . _ . -------- - . ... ........... - Private Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Ciay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ' 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 seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size y� -/L �-X.. '10--- - - ---------- Liquid Depth ..�'.-- -._.... . ;y..I�i6 0 ..- -Type------I �- Ca acit .. Mate . ��. No. Compartments ' p - Distance to neI t: Well__ � Z __ _ __ -...-Foundation .._.. .. . Prop. Line..LEACHING LINE [ ] No, of Lines . .. ...... Length of each line._..... —, T�6......-------- Total Length ..!-.�j..a 'D' Box ... Type Filter Material. . ... .. .. Depth Filter Materia!_______ .-.._ �epth is;nce to nearest: Well....... ...... --- Foundation.--.---------------- ----- .Property Line...---- -.- SEEPAGE PTT [ ] _ .. .. Diameter-- ----------- -- Number. . -___. `-----------..-.. Rack Fi!€ed Yes No ❑ Water Table Depth---------------- ........_Rock Size.... " dr� ------------------ Distance to nearest: Well- .___...._ Foundation ......_._._. Prop. Line REPAIR/ADDITION (Prev. Sanitation Permit#............. Date_............. Septic Tank (Specify Requirements) Disposal Field (Specify Requirements) ---------- - ----------- ------ ---- -------- ....... .. ................... - (Draw existing and required addition on reverse side) I hereby certify that I have 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 licensed 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." Signed .. .... -Owner _n ...... By._.... ZI Gam, - -- Title (if other than wner) FO DEPART NT USE ONLY APPLICATION ACCEPTED BY.---.--- .�. .. ................. .DATE 7 ..._......._. DIVISION OF LAND NUMBER DATE. _ . ADDITIONAL COMMENTS ___-- ..-- . ..--- --. . .. . . ... ............. .. - .. . . . ----------- ----.. Final InspecTion by: Date _ L �i ..-- EN 13 24 SAN J QUIN LOCAL HEALTH DISTRICT Fas 2167 7 76 3M