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FOR OFFICE USE:. APPLICATION FOR SANITATION PERMIT ------................ -mo �, .., Permit Na. .7,c/ (Complete in Triplicate) � ,.......lC�/..� ...................... This Permit Expires f Year From bate Issued 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: JOB ADDRESS LOCATION G .�.. . . .. ....:.. CENSs;<5'TRACT / .�_. ;;.r......_. ........ --•-•---• ............... ,�Owner's Name ..._•�'#'fs+,A..........:.. Phone .. . �,�.3z ..-.. .-. . Address ....... ( �.,... ----- -------------- - ------ .----•............. .. City Contractor's Namel� ,«,_ .4-_ .—fA&"1e11..-.AX. ��..License #o?b Installation will serve: Residence Apartment House-E] Commercial []Trailer Court 0 Motel ❑Other . --....-•----11 •---------------------- Q t Number of living units:..`..,.. Number of edrooms .._=.:..Gorba a Grinder-6...... lot Size „ Q . ................. Water Supply; Public System and name ....-.(,,� -.-- ---------------- --------------Private Character of soil to a�de`pth of 3 feet: _Sand 0 Silt 0 Clay,❑ Peat❑ Sandy Loam Q 4 Clay Loam C] Hardpan ❑ Adobeg 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 , �['ES r/ `tig----------------------------------------------- Liquid Depth ................. Capacity Type -- ........ Material.._... .... .....•- No. Compartments --......... Distance to nearest: WeII ........:......... .Foundation ...-�...........- Prop. line ...................... # LEACHING LINE No. of Lines .--_ . . Length of each line, �J g g Q.. ..,:. .._... Total Len th 'D' Box Type Filter Material ._De th Filter' Material �� YA ... p 1-�.-.-.. Distance to nearest: Well .GCJ-...-.------ Foundation Property Line .............. SEEPAGE PIT ] Depth S`Y�... ... Diameter2.2._ --. Number Rock Filled Yes)p No ❑ Water Table Depth ,... .d r .-Rock Size . Distance to nearest: Well _/110 ... .---......Foundation ....dProp. Line'~'.:�............ REPAIR/ADDITION(Prev. Sanitation Permit# --------- -.-• ........ .................. Date ............:.- --.-•) Septic Tank (Specify Requirements) - - --------- --- -- --------------- - ---- -- - - Disposal Field (Specify Requirements) .... -. f .._..;•...._-.- - - -•---- .. . -Z�Dr w existnd required addition on reverse side) J� I hereby certify that I have prepared this application and that the work will be-done in actor ante with $an .ioaquin 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 .... . Owner . . . . _... .. ............. 8y . .. elf .. . .. .....-.../� .. ... . ............................ .. Title .. ......, ..... other than owner) — FOR DEPARTMiENT USE ONLY APPLICATION ACCEPTED BY . . . ... . .........;. DATE BUILDING PERMIT ISSUED ......... ... :. ......................... - ----------- --- .. ...... ---....DATE ........... ADDITIONAL COMMENTS ,_ :............................ ---- ---- -------- ........... -- •------ ------- --------------------------- --• --- . .......................... .............-.......-- ............................. ............. -•-•----- -- __:.:_.......... ......................-......................... .. .............................. ............ . .. .... ..... Final inspection by: .. •-•--- -------------Date ...... .. .: - ..:SAN.JOAQUIN LOCAL -HEALTri DISTRICT [ u 13 24 , 7 17n 1 U