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I! FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -.. .......................................... Permit No./ .... -•.7 (Complete in Triplicate) ..............- .-r�.--...7....�. i. .................... This Permit Expires ] Year From Date Issued' pate Issued � y 01 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 Regulatidns: ....CENSUS TRACE' -., ...... J B ADDR-ESS/LOCATION :..__�...._.. Owner's Name` .:---•----•-••. •............. ........... ....... .... Address ....._..... City .... Ph n ..... ..... ........ Contractor's Name { . R{2siEN3 License # .1� ... Froze 1 Installation will serve:- Residence'&Apaitrnenf House ]{Commercial ❑7railer COuit ❑ Motel ItOfher :} _ r f Number of living units f Number of bedrooms _. Garbage Grinder LOt Sizer ................................... �4 -; :Private Water Supply: Public System and name ..,__ ........................ �--...._ C], ,-�»P tSand Loam Clay loam � } eet: -Sand❑ , Silt-0 `%Clay ❑ Y 0 y 0 Character of soil to a depth of 3'f-- - .�. Yes,.fi+Pe�---------------------------- — - Hardpan; Adobe ❑ Fill Material` IfIr (Plotplan, shbwing size of,lot,,.Idcotion of. system i'n relationi-to'wells, bung's, et`r! must be placed on reVeKse side,) �,+� NEW INSTALLATION: (No septic tank or seepage-pit permitted if public sewer is;available within 200 feet,( ? NT ( ] SEPTIC TANK[ ) Size-_= r -r--- = Liquid-Depth ..::: ............... Q PACKAGE TREATME Material__.... ._.....- No. Compartments Capacity .... ............... Type •---•-•----------• p - _Foundation .. Prop. Line Distance 4o nearest: Well -------..............--•--.....---- ... v --------- ...................... .. Length of each line----------'• ---:..�-._._Vt l length ............................ LEACHING LINE � ] No. of Lines _____________________ g , , - 'D' Box ............ Type Filter Material _Depth Filter, Material _____________ Distance to nearest: Well ........................ Foundation _____._____ ............ Property Line ........................ SEEPAGE PIT ( J Depth -------------------- Diameter .._-_----_---- Number -----------..............., Rock Filled Yes ❑ No-c- ' Water Table Depth Rock Size .................................. � ` Distance to nearest: Well ................................. �. Faundati�,_onb__-------- .......-. Prop. Line ___......_...---__-.-- REPAIR/ADDITION(Prev. Sanitation Permit# ................•••............... •---••--• Date ....... ...................... ....I Septic Tank (Specify Requirements) ................................. ............... ----•--•'----•---.................... ......••-•----.................. .. Disposal Field (Specify Requirements) ..... -...... ` ° ..................•-• ----------......----••-•- ••--••-------- ....... p' -- ............ Q'b'a^ o--'------- ......... 91. - 4tiA•�t�_.�5.?_ ._. ... • IiJim_ -_...._. l ------------------------------------- .__....._.__........__..._._._.....--•••- (Draw existinn d 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 llcen. 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 became b(e It to rkman's Comp nsation laws of California." Signed - . .................-•---•. Owner ----- BY._. ------------- --•-------...--------...._._.......----••-----._......---------...----• Title _... ,......__. -t._.._..., ....�(1f-'otFie�"t�iar5-ownerl; ,...�...�. �. .... ..� ..,w, .. ..- _ _ _ � -• _. .. � .. FOR DEPARTMENT_ USE ONLY L3 PPL'ICATION-ACCEPTEwD-'i3Y .. �: .............. DATE 3 UILDING PERMIT ISSUED _. .. .... .. - __-•_ - DATE ADSDITIONAL:COMMENTS ... .G1 :... }. �• i ... __ __ _ -- .- ....... 4.............. ... - .• _ - -r-- .. a-.... .P Final inspection by ... ._....... - 1 o o s CT , .......... -. ,. .. . ..: ... .... . EALTH DI TRI. ,. 'SAN•°'J ,AQU1N-••L •GA`L...H J. i= X13 24 1_•Agi va., a►u