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FOR OFFICE USE: r _ APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. : „ .......................I.................. ..... This Permit Expires i Year From Date Issued Appl€cation is hereby made to the San Joaquin local Health District for a permit to constrcict and Install the work herein des d. Timis application is m de in compliance with County Ordinance No. 549 and existing Rules and Regulations: «GC�D� _; t-f:f_C9-'-�{cit (? �' JOB ADDRESS/LOC .... lZ ,.- ..... - .. ..�•-•- •- - 1��1.sp,•° •- .... ..._�Zv".....CENSUS TRACT� T2 _ ..... Q..__.. .5:.OG Owner's Name .._...... ,(.�_:-. Phone -_-.- Address ........ ..... ..... Ci 3 ...: Contractor's Nome ............. L€cense ".}:3 . ..... Phone . ? Installation will serve: Residence❑Apartment Ouse Commercial❑Traller Court ❑ Motel ❑Other. Number of living units:............ Number of bedrooms Garbage Grinder _...:.::.... Lot Size . .. Water Supply: Public System and name Character of sail .,.................:...:._._......_......... .... ...... _.�.Private ❑ .... to a depth of,3#eat:� )San +[ . S�#❑ Y �t .. — r Clay ❑, Peat❑ Sandy Lam - ;:Clay-gym Hardpan 0 . Adobe Fill Materlaf ............. If yes type................ ............ (Plot plan, showing�si1ze of 'Int, location of system in relation to wells, buildings, etc.'must, plated._ori reverse side.) 1 NEW INSTALLATION: 1 Na septic tank or seepage pit permitted if publi sewer is avail b1e wi Y i i') i 'V thin.2 feet;# PACKAGE TREATMENT J,] - SEPTIC TAMC Q } Size. •.:_.. ------ Liquid Depth _ Capacity --•................. T ----•-•-_---- Material Yopartment� ..:................... p , �,. � Distance. to nearest: Well _:--_--._Foundation r o Prop. Line . LEACHING LINE No of Li s +' ... f }I � -•................... Length of each line.. . Total-Length "�-- 'D' Box ......_..... Type Filter Material Depth Filter Material ... I � Distance to r3tieares#• Well __ s ... . .......... Foundation Property Line .. SEEPAGE PJT ( 1 _Dep h � Diameter �.. Number ...�Rock tFilled M Yes !N ❑ i ." _ ...�. Water Table Depth .......... -•.............•. -•...______--••-•.Rock Size ......... yb Distance to ne'aresh;Weli -Foundation ......... Prop. Line ....................... REPAIR/ADD1TlGN.�P`ev nitcitionPe�it ". _...,. •-•--- .... Date ._ .. .............) Y Septic Tank (Specify Requirements) ...:.......:............•............-:..:...... - ----------- -----.- I ` Die osal Field (Specify Requirements) ' - --f r X-�'-��---•--- _ . -------------------------- (Draw existing and required addition on reverse.s€de) ---- -"' 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 ' lieen- -96d 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 a as to become subject to Workman's Compensation laws of California." Signet) ..--- Owner By - -- --- -- .............. .... title_... .:._. ------- ot r an owner) FOR EPARTMENT USE ONLY APPLICATION ACCEPTED BY _ : DATE L9-- ,� ..:... -------------=__....: BUILDING PI PERMIT ISSIfED ....-----••-._.. .. _ " ADDITIONAL COMMENTS ----------------- --------•------ ----..---- -- -----DATE ._ ............................."__.-.--------------'--------- .__..... _ �� /` Final Inspection by: ...----•.•---.._-----•��``,� , . Date 713 3 _ . --. i SAN JOAQUIN LOCM HEALTH DISTRICT $/?!, 3M