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i FOR OFFICE USE: 1 �............... ................1111........... ....... APPLICATION FOR SANITATION PERMIT (Com late in Tri Ilcatei Permit No. .j3` .%... A p �/ Date Issued •••-•�•••-•----•.•••••-••1111This hermit Expires 1 Year From Dale Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein i described. This application made in compliance with County Ordinance No, 549 arid. existing Rules and Regulations: i JOB ADDRESS LOCATION Q-r�e JJ • ir_._..h d S ADDRESS/LOCATION I .....y. ...........1..11.1................CENSUS TRACT ..............., ::... Owner's Name f.._....1.J.s-.v..�_ �a.ra................ .. ..Phone A'J ............ Address ............ ........ 1 ,,V` If,...,t1%1.�9 ►-^�------ --• City •................ Contractor's Name ..&A. .Z. 4;�; ..:... .....License # X7147-,�$_---.. phone '��,�..��f6...... � '�fi...._. -- -- ••-•-------------1111..-•---------1111-. ; ---- a Installation will serve: Residence C&Ag rtment House] Commercial oTraller,Court 0 Motel 0 Other ----- ----------------•--- � Number of living units:---------t+. Number of bedrooms ......:.Garbage Grinder Lot Size ................ I Water Supply: Public System and name --_-.._,.........._ ........ .................................Private .....` .-. ......... Character of soil to a depth of 3 feet: Sand [ Silt❑ Clay (] Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ * Adobe ill Materia! ./1/a.. If Yes.typeY....................1111... (� (Plot plan, showing size of lot, location ofsystem 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 ... . ..............1111.. Liquid Depth .1��% /� - ........... Capacity ...- ----- TypeA96-&-e-Material-C. 1)3e '- No. Compartments �^�J �b Distance to nearest: Well r._ .:Foundation ._�4�. Pop. Line,6.7 LEACHING LINE [q--No. of Lines ..-_-aL.-------------- Total Length .......... '17' Box .. Type Filter Material Ck__........Depth Filter Material q ........... ( Distance to nearest: Well ...S-Z.............. Foundation -e-Q------ ......... Property.Line . SEEPAGE PIT Depth .. ....... .__ Diameter ........ plumber ....D ................... Rock Filled Yes •E]�No ❑ i J. .- Water Table Depth ---• 4.1............... -••---. Rock Size 1ei...eY- Distance to nearest: Well ......_.lam.......................Foundation /P " REPAIR ADDITIONSanitation Permit# ... Date ..................................) fop. .Line ....._..._...___._ (Prev.{ _.................................1111__. k Septic Tank (Specify Requirements) , Disposal Field (Specify Requirements) .....-..................................................................-.......... 1.111 ....-._-.........-.............__. ; ------------------------------- ------------------.................•........---------------...................--...........-................................ -1111..--------- ---- • - - -----------------•-------•-•--•----1111-------•----••--• (Draw existing and required addition on reverse side) 1 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 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 laws of California." Signed ....1111....•............ .................... / . - Owner ' ��-.-_ By .............................. e:�/- ! _-----.. . ------. - -Title ..----.-��.................:....... (If at t on owner) FOR DEPARTMENT USE ONLY r, F APPLICATION ACCEPTED BY.... ..._-.. - ... ... :.........:......... DATE 1111-11 1 1.. �`�.... .. .._...... ADDBUILDINGP RMIT ISSUED -- ----- ----------------------•----•--•--...------••---- --•... .......... TE ........................................... L C MENTS f16:......................... ,�}_ _ _ 1. . - - ......................•------------...........--•. .. .... .-----•-- ---- .................... . ... ..•-- ---- Final Inspection by: --..:-.. Date 1 ................... 1111 .... ... ..�3......... -- —- _ � ,SAN•JOAQUIN LOCAL HEALTH DISTRICT P A - r.. E..H. 13 241-'68 Rev. 5M -7 1 17 1) z �.