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FOR OFFICE USE: / 7vAlk APPLICATION FOR SANITATION PERMIT (Complete In Triplicates Permit No. .. ..._� r This Permit Expires ll 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 u described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ._... -D-s._.`] __fir................. .. ............. ................CENSUS TRACT .......... Owner's Name ...__.... .C(.i ---------- ..IjlA........................................•..........._........................Phone i!. Z5w.._..----•-. Address ._ ._ ..f •.. ....... _ .LAS ....................-•.................. City ........ lC. N.,................-....-•---........... Contractor's Name ...... AC-72W'7Z .1 Z;? -5-��255 --- IWO,..Llcense ... Phone ..5 .:Xk Installation will serve: Residence WApartment House(:I Commercial OTraller Court 0 E .v. Motel ❑Other................ ..................... ..... � i Number of living units:__.-,------ Number of bedrooms _- .....Garbage Grinder ............ Lot-Size-..... a.... 1C•.1... C�.......... 1 Water Supply: Public System and name .................. 1v_. .� ....... 9�!"..................................................Private ❑ j Character of soil to a depth of 3 feet: Sand Silt Cla Peat Sand Loom' Cia Roam p ❑ ❑ y'❑ ❑ y ❑ y D Hardpan (] Adobe' Fill Mater#al ............ If yes,type ..............z, (Plot plan,- showing size of lot, location of system in relation to wells, buildings, etc. must be' placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200:Beet,) PACKAGE TREATMENT f ] SEPTIC TANK Size..... __ ,x-c:Z.,aG...9........ .,,'Liquid Depth .:......--- Capacity/ .0.._._._ Type . : Material. . . _ _ No. Compartments ....... f I Distance to nearest: Well -----N.amtj,A;____________ _Foundation .---•:!p!------ Prop.Ilne .....,, ......... M1 r LEACHING LINE No. of Lines .......•-/-----_---- Length of each line.-- ---._..,Toth! Length .........d. s2.'. -J t 'p' Box ............ Type Filter Material Depth Filter Material ............. !=f......................... Distance to nearest: Well ---.IA,�Y�... Foundation ..._.../ ...`........:Property Line ...'... .'_:.::..:. SEEPAGE PIT Depth ...... Diameter ...3.3 .'Number ........I................. Rock Filled :'ffies No i❑' ' ...Rock Size .......Z.s�.r•.... ...... ....... ► i Water Table Depth ................�,�--,-=••--:------__-- . Distance to nearest: Well ._._/.Sl4N.C-_-................Foundation ----- Prop. Line . REPAIR/ADDITION(Prev. Sanitation Permit .. Date ........................ .......... Septic Tank (Specify Requirements} ....... ..............................-.......--------------• '...--.............................'................ ...._ Disposal Field (Specify.,Requlrements) ---------_----------- ........--............................ ......... ---------------------- ------• ---......_.._... ------------ ------------ .. x (Dr w existing and required addion reverse del tion 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 Son Joaquin Local Health:District. Home owner or licen- sed agents signature certifies the following: i "I certify that in the performance of the work for which this permit Is issued, 1 shall not employ any person In such manner as to become subject to Workman's Compensation laws of California." Signed -_--- .._ Owner By -•• � -- ---- - -------•- - - - - --••-•--- ---••-----._....--•-- Title .......... -_ ---•-•-- .................. (If other than owner) 47 FOR DEPARTMENT USE ONLY •------ DATE _.. ......_ APPLICATION ACCEPTED BY -. 20- .. ' BUILDING PERMIT ISSUED --=----------•---- ..... •--.._ _....._.._...._... -----•---- -----....... .........DATE .._..._.._..--------- ADDITIONALCOMMENTS ----------- ---------------•----......__._...---....._._..._..._...__._.._......_....__.._.....-•------•------------•----...._.....:.........-•------......_.._ ------------------------------------------------ --------------------- ... ------------------------------------------------------ Final Inspection b Date P Y - V ----------------------- --c EH 132L1`x8 lie • 5H SAN JOAQIJAL HEALTH DISTRICT 8/7h M