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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT _..__......_................. I Permit No. ... (Complete in Triplicate) , -......--...............................I................ \i ' Date issued ..7`-=_-•.----f••• ................ This Permit Expires 1 Year From 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/LO TION .. � v`"`"`-- -.-'' � 0 ......CENSUS TRACT _ - . ..........,.......... ho � Owner's Name .....-... .... --- City .. . ._. .. �.......�_. r..... .`.^ p ... 1 e Address p ------ --.License #31.7Pore Contractor's Name cJ_ .....D• - •--7 Installation will serve: ResidenceApartment House Commercial Trailer Court 0 � p —TMoteI❑Other ... --------------------------------- - ) t Number of living units:..... ...... Number of bedrooms .-..-.--.__-Garbage Grinder .. ..-..._._ Lot Size ./ ��• -� = Water Supply- Public System and name ............... ....................-.............-----Private Character of soil to a depth of 3 feet: Sand n Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ , Hardpan ❑ Adobe ❑ Fill Material .._. ..:.. if yes,type :. ---- -_ --- •-• f (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. -must 6e placed on reverse side.) 1 NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ SEPTIC TANK j ] Size.-��Co0......................_..._._._ Liquid Depth ......................_.__ 6 - Ca acit Type Cr_----- Material. ......... ....•-_ No. Compartments -•--------•------5 P Y -- - Yp �. r �-- Distance to nearest: Well . /.4Gi.f---------------------Foundation .. ./.4 s{.-.- Prop:Line LEACHING LINE [ ] No. of Lines . 3 ,,. Length of each line .-y0 .......:.: . .• Total Length ........... ' 'D' Box .�- _ Type'Filter Material __ell -____-_Depth Filter Materialx'/---4'"'-- ...-•-- ./00------- Foundation Property- line .�-�"--`:--•....... 3-uyK,f + Distance,4o nearest: Well ./. .- !4 f :' p �EEPf�E "PfT [ ] Depth dhl'8 Q0 qe'4 r ----- = = Number _.3....r.......... ...... Rock Filled YeSA No Q�' Water Table Depth .".'" ---�- a _...Rock Size ......... . ........ ......•-•- Distance to nearest: Well .../04>- ..........._..__.__. ...Foundation ....... Prop. Line •r_f....*....... REPAIR/ADDITION(Prev. Sanitation Permit -__.-. - -----, - , - ....... ...... ............ .................... Septic Tank (Specify Requirements) -.-- .... - - ------- ............... . a Disposal Field (Specify Requirements) ... -`".._ _..... .X. x ---------------- *........ .... . ....... - (Draw existing and required addition on reverse side) ,: ,_ �_.- I hereby certify that I have prepared this application and that the work *ill"be done in accordance w t San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licew sed agents signature certifies the following: ' "I certify that in the performance of the work for which this permit isissued, I shalt not employ-any person in su h^manner as to become ubject to Work�n++gn's Compensation laws of Califortda." - ' x � Signed ------ • ---- -------------- ------------ ------ ---."__-- Owner� - .. :�°"r7ritleBy ... _ (if other than owner) [ FO EPARTMENT USE ONLY _ �� ".��..�4..w.cu..t..om�.... ..... DATE ....... PLICATION ACCEPTED AP ......DATE . ....... .... ._......-._._._.-__. BUILDING PERMIT ISSUED . .._ _.._.. _ •--- ----------- ADDITIONAL ------. _ ADDITIONAL COM ENT5 ..47.w 1 Vicq , o/ . 4ivH.YI- : G -..,4A4.0..-.----...-- s ------- T! �f .... Final inspection by; .. .._. '" Date . .. ..t. ----...._.. . . r.:..... ' --- SAN JOAQUIN LOCAL HEALTH DISTRICT 7/723 ,4