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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT r.Y IComplete in Triplicate) Permit No.7-,.r-.':.��JZ ......... This PermitExpires 1 Year From Date Issued Date Issued .I............... Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application made in co_Mp lionce with un y Ordinance No. 5,49 and existing Rules and Regulations: i Vct ✓�• t /Oe JOB ADDRESS/LOCATION T = :S'�"/l1"' .ZJ: le /1 C ". Dry '450 12. -1:,................CENSUS TRACT ._._..-.. .�._.....--- Owner's Name T� k.ey......................I................I..........I.....I...Phone .................................... Address .......:............./--7----.-.........._...-_...---.._.--_..---....... ._._:__-... ............. City ................................................-....-..............-...... . Contractor's Name .----•-• ....-...--.............................................License # ........................ Phone .............................. Installation will serve: Residenceo Apartment House❑ Commercial❑Trailer Court 0 i Motel ❑Other---......................................... Number of living units:-.--/__--- Number of bedrooms .......Garbage Grinder Lot Size ...-.-...... ........................ Water Supply: Public System and name .......................... ..........................._.......----ti.._.............................. Private Character of soil to o depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam (] 111) Hardpan ❑ Adobe 0 f=ill Material ............ If Yes,type:f........... ...... :.. (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be�placecl on reverse side.) I NEW INSTALLATION: (No septic tank or seepage pit .permitted if public sewer is available within 200 feet;)- PACKAGE TREATMENT [ SEPTIC TANK) Size______Z1X_5�.lt_ ----------___......... Liquid Depth ..............� J Capacity _ Type _ Material___ _ ______________ No. Compartments Distance. I near st: Well ____________________________________Foundation ------- -------------- Prop.-,Line ....................... LEACHING LINE No. of lines __. •Length of each line....�j Q..._x.3_._ Total Length _,_!0.............. • f/ 'D' Box .._._-:_... Type Filter Material�7iC -k..........Depth Fuer Material ....................... Distance to nearest: Well ..... Foundation .......... ------. Property Line......................... SEEPAGE PIT [ ] Depth Diameter -------------- Number-_---------..__.............. Rock Filled"-Yes ❑ No Water Table Depth _.__...._. ................ .........:Rock Size ............................. *` Distance to nearest: Well ____________ _-•_ ---------Foundation ..................__ Prop. tine ........................ REPIR/ADDITION(Prev. Sanitation Permit# r-- ----- Date'_____________________________ _"�c Tank (Specify .Requirements) ............................. ......- ............................................................. .........---._ ........... Disposal Field (Specify Requirements) `'G -- U - l ct c G �'J j -•-•-----•-.......---••------------------•-•----•------•--..._._ ---------------- - ----- ----- •----- .......---•------------------------------------- .--._---------------_------------------•------------- ` (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. Hoene owner or Ileen- 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 mann; as to be a ble to.1 ��maan's Compensation laws of California." Signed __: `_.. I "- .............................................. Owner By ----- --- ------ Title ........ --- (if other than ow I _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY�__<- ---Y--------------------------•--•------___-- -----------------_----- ------------- DATE .. :.:J_?:_ 7�•-r-_....= ....: BUILDING PERMIT ISSUED ------------ --• ---DATE ----- ADDITIONAL COMMENTS --_-.--.--- - ... �._.. -------------------------- -------------------- ........................ . --------------•--------••---- -----------•---.......--_._-..............................---------------------- ._. final Inspection by: -~ ^----•----•-•-.•. ------------- `-�-�--_._ ._._...----------------------...----...:...---------�-•-•-•-----.:.-_.._.._....-.-Date .... ----•---.........._.........-•-- EH 13 24 i`5 v• 5mSAM JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M s