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FOR OFFICE USE: . 411_� I —AFPUCATtON FOR SANITATION PERMIT (Complete in Triplicate) Permit No. This Permit Expires 1 Year Front Date Issued ©ate Issued ../........__..... Application is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work herein described. This ap lication is made in complion a with County Ordinance No. 5:49 and xisting RuI94 and Regulations: JOB ADDRESS/LOCATION 'rte r�S �O R �....-•---• -•- - -- ....._ .CENSUS TRACT Owner's Name .............I........•. --• -........... .._. .. . .. .........Phone Address .................(. ._( _. _.. .4... • .-- --• -------.....City ..�Pa .. Contractor's Name .--_U,._)..t-- -.f - .....:.. ............ ..................License .... Phone In will serve: Residence B�Apartment House Commercial❑Trailer Court 0 Motel ❑Other........... .......... Number of living units:.....L... Number of bedrooms _.....Garbage Grinder Lot Size ... PIWater Supply: Public System and name ............................................................. ..................................... .. r a o Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam X Clay Loam ❑ Hardpan Adobe ❑ Fill Material ............ If yes,type............... ............ (Plot pion, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on reverse slde.) NEW INSTALLATION. (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) Q) PACKAGE TREATMENT { ] SEPTIC TANK Size_./�.? ._ .�... r . w .......... . Liquid Depth -- --------------- Capacity _�.00-.v..---- Type P94n,44'k- Material. _... No. Com artments ..................... v . CA i Distance to nearest: We ...oE�_ Fou ation ._-........f� ., j� 2 - ----••-----....-•.--- Prop. Line . LEACHING LINE ( No. of Lines. -_-._-- ...,...J----- LengthIf each e..--- ..p (l / Total Length°D° Box ...__.. --- Type Filter Material - - a__ _-- ..Qepth Filter Material .....-.....� ".._.............Distance to nearest: Well��.f... ---- Foun anon ...?�1d. �� -•----.. Property Line .......... ............ SEEPAGE PIT [ ] Depth -------------- ---- Diameter ... ......... Number ----------....._... _----- Rock Filled Yes ❑ No �❑� Water Table Depth ...---------------- - -----------••----.-Rock Size ---------•••--- -••-=-----•• Distance to nearest: Welt ........................................Foundation .................... Prop. Line r ' REPAIR/ADDITION(Prev. Sanitation Permit# ...7..T? `f................... Date l_c? y`f 7 ...... Septic Tank (Specify Requirements) ...:.--•••-••----. - .... -•--••--•---..._..........._...-•••-....-•--- - Disposal Field (Specify Requirements) ....... ....... _--•--•--............. ----------------- ------- ---------_-----------------------------------.........................•--...................... _.:........................................ -1 - (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 accordaince with San Joaquin 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 suble7o Workman's Com ensation laws of California." .Signed _... � . _ _ 'F - -•--...--•----•------ •- ----•---- fir" By ---------------------------------------------------------------- - � - ..-•---•----- Title ------ _... .... ----•--.... (If other than owner} FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _._.-----._ -- - ---•----------•--- ••------- -------___: - .. -- --- ------- DATE BUILDING PERMIT ISSUED ----------� .-----..DATE ---_----------- ADDITIONAL � COMMENTS --------------- _-__.-. _ --- ---------------------------•-------_... .--•---------•-- ••---•--•... .................. •------------------------------------.............-..........-.-.-----------• ._..__._._...-- ... EH Einal Inspection b -- SAN JOAQIiIN LOCAL HEALTH DISTRICT/ Date . `��.. 7.�_-.---- �3 2a 1-6f3 lfev. 8/7h 3M