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_ e+ FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit_ No. ..��'....�_. r (Complete in Triplicate) .............................................. j This Permit Expires } Year From Date 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 ,. -._... CENSUS TRACT ..... ......,., Owner's Name r/J/ .. 7`�r3 .1.E_1'16.------.... •...-.•� . -- ...... W �-- _.. ............. ! Address .....1R..._a,.._.L6a.. 5F..-...-••-•--•................................. City .6f6�Auno. .. •-• -z/ ...... ...... Contractor's Name ._.!r�,_e� :�... _lf�'/�...................... ......................."- License ....... Phone . -�lE'.T ....... Installation will serve: Residence ® Apartment House Commercial ❑Trailer Court ❑ Motel ❑Other ----- -----------•----•------------------- Number of living units:..../...... Number of bedroom ------Garbage Grinder ............ Lot Size .................. ......................... Water Supply: Public System and name ........•-_ •-- -- ---- ED - Private r _ , _Si _ ..,_ . Character of soil to a depth of 3 feet: Sand Siit❑ Clay ❑' Peat[] Sandy Loam Ciay Loam Hardpan ❑ Adobe.l] Fill Material ------------ If yes,type ............................ (Plot plan, showing size of lot, location ofsystem in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: _(No Septic Ink or seep ge pit permitted if public sewer Is ov ilable within 204 feet,) 19 PACKAGE TREATMENT �[I. SEPTIC TANK f.� - - -tire._.__..._•.--•=--------------------• ---........ .Liquid Depth ............ PACKAGE +, Capacity . :.................. pe .................... Material....--------------. _. No. "Compartments ...:... .... Distance to nearest: ell ....................................Foundation .____....... ------- Prop. line ........••...___...... LEACHING LINE j No. of Lines ................ ...... Length of each line..................... ....... Total Length ............................ 'D' Box :" -___ Type Fi ter Material .....................Depth Filter Material .-•..................................... =--° Distance to nearest: We ........................ Foundation --..---.•_.. Property Line ........................ SEEPAGE PIT [ ] Depth Di eter ................ Number --------------- Rock Filled Yes ❑ No C3 Water Table Depth ....Rock Size, r ` Distance to nearest: Wel ,------------------------------------Foundation -----------.. -__. Prop. Line ...................... 4 REPAIR/ADDITION(Prev. Sanitation' Permit�# ................_.......................... Date .................___. ........ l Septic Tank (Specify Requirements) ..� a. 1�9�..---•S- D---'--C---Tfiv/ _................. Disposal Field (Specify Requirements) .:��.•..: �.5�--------------- - .. —;-----------------------•-- ----*----__....._... . _".----------------------- ------ ----- .------------------------------ ......_.. ------------------ -------------.............................................................._.............. ............................................................................. (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. Horne owner or licen- 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 become subjec o!7�'7 _7 p`ensation laws of California." Signed C• ` • . • .-.....- . Owner ....----• Title (If other than owner) FOR,DEPARTMENT USE ONLY .-._ _6..C0..•----•................................... ........••---•--••-'-------------..., DATE .... _ ..:�.1-_-_7 APPLICATION ACCEPTED 8Y �f ---••--• BUILDINGPERMIT ISSUED .........._f•• .. ................••-.....•-•----=-------........I........__...-----....__...............DATE _............---------.._.... ..... •---- ADDITIONALCOMMENTS .......... .... ................................... .......................................... . ....... _.. ---......... ............ ................ .-- -------••------- . ..... •---............------------. _....._........--•---...------................................ _ ........ Final Inspection by ...........:.....:...................•---.Date . * _ SAN JOAQUIN LOCAL yHEALTH DISTRICT _ 7/723 M • � L-1 13 211 1_'/,R 9.,, RAA —