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FOR OFFICE USE: .. APPLICATION FOR SANITATION PERMIT S vwtj D 70 1 .............. ........ e tComplete in Triplicate) .l 11--r P rmit No. .. ...`. ��.- G ICD ate Issued !F:' ...... �:..... .................................•........:.-.... This Permit Expires 1 Year From Date Issued L1� ._._ Application Is hereby made to the San Joaquin Local Health District for apermit to nstruct and install the work herein r described. This application is 'made in compliance with County Ordinance No. 5'49 nd existing Rules and Regulations: a �J yy-- JOB ADDRESS/LOCATION ..-... .(Z_....... .........� ,��.1t_R.%. ...............-....CENSUS TRACT ..... ......... Owner's Name .................DIVE...... ............... .. .... .....................-._........Phone .-- Address .... ••--•---•„42. .3.%--.. ... �' I .� .. _.CitY - .-.�4-............................. Contractor's Name ------ -1. ± -- ------ 1 _.- --------------------- -- --=- License # -2-I.R.M.1--- Phone f_ • G aGJ G-'Za A/ �3�/ � Installation'will se �� esidence Qq Apartment House orn ial OTrai€er Court C] Motel❑Other .....---••--••----•...................•-•- Number of, living units:--_ ------ Number of bedrooms 3...:....Garbage Grinder fs---- Lot Size ..../V.- Water ..Water Supply: Public System and name ._._----- ---------------------------•----------------------------------_..--•• •------- ...........Private Character of soil too depth of 3 feet: Sand❑ Silt❑ Clay .0 Peat❑ Sandy loam ($ Clay Loam ❑ . Hardpan 0 Adobe 0 fill Material ............ If yes,type............... ..........:. (Plot plant, showing size of lot, location of system in relation to wells, .buildings, etc. must be placed on reverse side.) W NEW INSTALLATION: INo septic tank or seepage pit permitted If public sewer is available within 200 feet,} PACKAGE TREATMENT { ] SEPTIC TANK j ] /s Size__ __ __ ___ __ uid. Depth _ ...' Capacity _11�Type N4-t __. Material_CDf1f1!4?l_ No. Compartments ..;L.. ............. = r Distance to nearest: Well __ . p- t _Foundation ..10.. ..Prop. Line 6 = - 'Length of each line- - -- ---._. Total ken th _.. .--- -........... LINE ( ] No. of Lines __-- g �-f g ��, , Qtr LEACHING `D' Sox ....I------ Type Filter Material .-�--�•-----.... epth Filter Material .....ct...= ...................... { ,9 - _... Property Line .. _ C -.. Distance to nearest: Well _-- ..�.Q�..:_._..__ Foundation _ _ i 1 p �... ...:... SEEPAGE PIT Depth ___ �1._'___i�__.._. Diameter�}� _/ Number . -.- •...... Rock Filled Yes No Q Water Table Depth .............j........'.........--.._.........Rock Size Distance to nearest: Well ----(. .- r ................Foundation 1. -- Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# _-----.------------- ------------- Date ... _ ............. Septic Tank ISpecify Requirements) --------•--------- `ice x 'C 4 ;1 .......................................... Disposal field {Specify Require tsl .. ......... .. -r / / .. ------------ .. r --- ...........................•-•----------- ------------------------------ ----------- - ---74 .--- = --- . ----- r Draw !sting and required addition on reverse side] I hereby certify that 1 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 Joacluin local Health District. Home owner or licen- sed agents signature certifies the following: - �---- -- - • - . - 1. "I certify that in the performance of the work for which this permit is Issued,.) shall not.employ any person in such manner as to becoVsub* t Wor s Corn ensation laws of California.Signed ------ --- Owner " 4 • --•-----•---- By ............................ -- �iD2°l-... ILv .,---------- 1 .- . .)`. : :.--0 -.. ; �--}} - Title -....--. ----•--- (if other than owner) v EO DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _.AW --------------------------------------------- -• - -• -------------- -----------_._. DATE BUILDING PERMIT"ISSUED .. --- ©ATE ._.. ADDITIONALCOMMENTS ---------------•--------. -• - ------------------------------------------ --------------- -------------------._..-..- ------------- ------ -- ------ ------ -----. .__.-... .-------------- .-.... -----.._--------..-... ,-.------------ ----------••---- ----------- -------------- .--•--- -------.-.------- ••-- .... Final Inspection b " � Date ... EH 13 2 1—bFi Rev. SAN JOAQI3IN LOCAL ALTH DISTRICT 8I71i 31''1 �.