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FOR OFFICE USE: V e APPLICATION FOR SANITATION PERMIT L_ro 7 Permit No. ..� (Complete In Triplicate) Dote Issued .L'7.:.7.v This Permit Expires I Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work heroin described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: GENSUS TRACT ..... --... R pp DD ... JOB ADDRESS/LOCATION _...Phone Owner's Name .. .. ... .._ po - - ..c..o..�/-j.-.. r,. Address / .2 / !/3-�.. C./it wt:.44. /�Ca�i... ..........City . c�c�.f• .... ... .......... 'a Contractor's Name � --s-�•- !` — - - License tlbZ'G•Y./._7 7- Phone /��r.,�•.�Trl..1'... Installation will serve: Residence❑Apartment blouse❑ Commercial jfrailx Court !] Motel❑Other _ ........ .. . .... ................ ` Number of living units: . C... Number of bed toms .r....Garbage Grinder .. - Lot Sixe .. �.-- ------------•....... Water Supply: Public System and name . ..... ..liJ •.................................................•Pnvate Character of soil to a depth of 3 feet: Sand j] It❑ Clay ❑ Peat❑ _Sandy Loam Clay Loam❑ Hardpan❑ Adobe❑ Fill Mctertal ...... If yes,type.................. . - t t.� (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) N'stW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet.) /• i PACKAGE TREATMENT ( ] SEPTICTANKIVY I CapacityACQ. "Size.,&?....! F..XLIl.......... Liquid Depth .......................... G.W. Type w Material.." No. Compartments ...T7............_. ' Distance to nearest: Well 6-ii;V.+...................Foundation 1 ............ Prop.Line..J.............. i d I • LEACHING LINE No. of Lines . _ �.... . . Length of each line..... ....• ....... Total Length .. Q-�•••-• S /� {, �� 'D' Box ._.�.. Type Filter Material �rt.R.'C.!S:......Dept�iltar Material ..�.�C... ......:...:� � ' } '• Distance to nearest: Well .. .'$?V...... .... Foundation . ._P............... Property Line !� •----••-••-- t ; x� SEEPAGE PIT [ 1 Depth .......__........ Diameter ................ Number............................ Rack Filled Yes ❑ No ? Water Table Depth .Rock Size ................................ ............................................... yDistance to nearest: Well ........................................Foundation ,................... Prop. Line .................... REPAIR/ADDITION(Prev. Sanitation Permit$........ ................................. . Date .................................. �. ......c �..�a..c.._. �* Septic Tank (Specify Requircmentsl ..........14 ----�-- X77 �•� ' Disposal Field (Specify Requirements) •••-•• -••----•- :.... ................................................................... -- •- t r 1. .. - [Dr.ow existing and required addition on reverse side) - '� I hereby certify that I have prepared this application and that the work will be done in aceerddece with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Hems,owner of 11I i sed agrnents signature certifies the fallowing: reen in web asartnor "1 certify that in the perforaeco of the work for which this permit is Issued, i shall net employ any Ps, as to become subject to Workman's Compensation laws of CalifondaP / 11 Signed ... -. ..... ........ Owner p . . � yt Title ...... .¢• .. ... ............. j. By (If other than owner) FOR DEPARTMENT USE ONLY - APPLICATION ACCEPTED BY - ...__..___._...................................._..... __....... ..... DATE...�..'�'....�................. BUILDING PERMIT" ISSUED .._.. ......._._ _......................_.DATE .........................5............... ._ - .. . .r ............................ ...... ADDITIONAL COMMENTS . . .. .. .. .. _ I. .. .Date..... '.. 2.... ... Final inspection by: . _. .._ . -" - SAN JOAQUIN LOCAL HEALTH DISTRICT