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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ................... ........... . .............`. [Complete In Triplicated _- Permit No. .7..` 22:�L �. �f.. k Date Issued._ :. 3 .. ;: , This Permitirest'.Yeatrnm Deslolil3iti�ado � J., Application is hereby made to the San Joaquin Local Health District for. a per to construct and install the work herein described.'.This application is made in-compliance with County Or in ce Nc, 5:49 and existing Rules and Regulotions: ' ' /(f7407 JOBADDRESS/LO 10 ._......... . ... .......•......... ...............................................CENSUS TRACT ----------_-----•- i Owner's N e ... .... . ....:'--- --- .......................................................-.......__._..........:.... Phone .............-^-.......... ------- Address ..............................City ...:.T.S3 7 a..............•----------------- ......�f�. . Contractor's Name .. ---------'License # .__..................... Phone installation will serve: Residence(ja Apartment House 0 Commercial oTrailer Court ❑ Motel ❑Other............................ of living units-_- Number of bedrooms Garbage Grinder d�Lot Size ..._ _.-. g .. .... --�- -1�k,R..__ �. Water Supply: Public System and name .................................................:...........................................................Private In Character of soil to a depth of 3 feet: Sand b Silt p Gay ❑ Peat p Sandy Loom 0 Clay Loam❑ ' Hardpan 0 Adobe 0 Fill Material .........,..1f yes,type •.............. ............ (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on reverse side.) S p. seepage P P public sewer is available within 200 feet,) a o PACKAGE TREATMENT [ ] : SEPTIC TAMC a e it permitted ..........if �_ d................... Liquid Depth ..� :............... !r Capacity -a _ ... 'type -.-Imo` '-'�` Materiai.._._� No. Compartments ----- -- -------- �.,/ ...... Prop. Line -... ...... . Distance to nearest: Well .----..-�-`Q....................Foundation _�.;,1..._---- [0�`!....... . Z -- Length of each 1 ' 3 . o .� tal Len th .. LEACHING LINE [ ]. No. of Lines ... -•---� �...'� 9 --•f`�•�---......._ 'D' Box _.l....... T e Filter Material,'--•�- _ '? pth .Filter Material �?-�!-r'....................i...... .F pistance to nearest: Weil -----7.�.`'.k` Foundation �,.J--_---.---- Property Line ..i�-p_. . ..._. SEEPAGE PIT [ ) Depth --------•--.....---- Disxmeter --------.-:.* Number ............................ Rock Filled Yes ❑ No 0 Water Table Depth oc Size 4 - L. 'Distance-to nearest: Well ..................................`_"...Foundation -_:............... Prop. Line ......_....... ....- ,a REPAIR/ADDITION(Prev. Sanitation-Permit: .........................:.............. � ...__ Date .......................... . -- � -•1 Septic Tank (Specify Requirements) ....... � _ '/ .. ... ` -----w---••N�------�-�'- ------- -- _ Disposal Field ISpecify Requirements) ---__--. -_ -................. y , • ..................................... ----- ...................................................-....----------. -.....-_... i ................... ---------•---...........- -------------------------- -----•--------------------•----------- -•------- -_----- ..._ ------------------------------------ . (Draw existing and required ddition`on`reverse side) a 1 hereby certify that 1 have prepared.this-application and that the warli'Will be done In accordance 'with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the Scan Joaquin Local Heal*District. Horne owner or Ilcen- i 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 t' as.to be me s to Workman' Compensation laws of Callforrnia." Signed ! --- -- ------- -------- •-- .. -....----- =----------•-••••......_•. '.._ Owner By--- --- -- ---- (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- ---•- ---- ------------ --------•- ------ -- ---------------:...DATE BUILDINGPERMIT ISSUED ------------•--- ------------------------ ........-................. .......................--...........DATE --------------------------------- t - ..-.-t ADDITIONAL COMMENTS -----__------•• —.........-. -------- ................. -----------------------------------------------L--------------------------------- ------------------------ .-----.---------.-.---------- ---..-...--.....---------------------------------------•-- hi _ ......................... ---------------------------------------..---•--•.-------._...---:---.------.--_--•-- -..-. .....................-.-... final,Irispectian bY: .. -----•--- --------------•-- ......Date ....-. -:.�,f`� ....-.....'. EH 13 2It '"6 �'• SAN JOAQUIN LOCA EALTH DISTRICT 8/7h 31"1 f: