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ti i. FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ......................... •------------ (Complete in Triplicate) Permit No. ��rl-.��. This Permit Expires y Year From Date Issued 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 meith q 'or Coynty Ordinance �N 549 and existing Rules and Regulations: s � `7 Y ...:I C R L_ _ 1 a c, !P.W..CENSUS TRACT JOB ADDRESS/LOCA TIO .._....- tA � A t� � y 7... .. Owner's Name ............... ................ ........:........ Address `7 `aE 2. ... $� CAre-Lo _�.CKi�. ._._. I .---------•--•---.._.... .................I........ City ...._..................................... Contractor's Name ------------------.License # Phone Installation will serve: Residence gi partment House❑ Commercial '❑Traller Court Motel ❑Other ------------------------------ -----------•- Number of living units:.... ------ Number of bedrooms _-......Garbage Grinder ------------ Lot Size ... ` ._.Aq;•& .................... Water Supply: Public System and name ....................... ................................. •----•----------•----•- ...........................Private Character of soil to a depth of 3 feet: Sand [] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Gay Loam Hardpan ❑ Adobe.0 Fill Material ............ If yes,type __________________________ (Plot plan, showing size of lot, location ofsystem 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 feet,) J PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size................................................ Liquid Depth ......._........... = ti CapacityType ... No. Compartments Distance to nearest: Well ......--------------------•.........Foundation ..._............ ..... Prop. Line ..................... . LEACHING LINE [ ] No. of Lines ........................ Length of each line..................----...... Total length ............................ 'D' Box _.__..__._.. Type Filter Material ....................Depth Filter Material. .................._._....._............. t :... 41 Distance to nearest: Well ------------------------ Foundation ........................ Property Line ._........._.......---=.. ' SEEPAGE PIT [ j Depth Diameter ................ Number ...._.....................-_ Rock Filled Yes ❑ No Water.Table Depth ... .Rock Size Distance to nearest: Well ........................................Foundation ---_----------.._- Prop. Line ...................... o ti. REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .....................•.. ......... Septic Tank (Specify Requirements) _.' 2t>Ca _G/a�..t__....�'+Q .SZ ... L.!1! !.! ........ .........................._.... - yQ 4, A�.kL......l,.i.ri'.t.. . X P.�..a . .4 Disposal Field (Specify Requirements) --------- - --- 'Su . ` _..__ 1_�i ..........................•---------••-------...-•----• ............................--------------..........._.. ............ -- ---------- ---- - (Draw existing and required addition an reverse side] � a 1 hereby certify that I 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 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 me subject to Wark on's Compe lotion laws of California." Signed r ................................ Owner $y . Title .................................................................. .. . ..... .....: t k (if other than owner) FOR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED BY . ...... .... BATE ----- ----------- BUILDING PERMIT ISSUED ..................... ..........................••-------- .... ,r.............................DATE ................ ADDITIONAL COMMENTS .... ......... -----•-- ------------•-------•----•.......................•----••------•-••-•------------- __.......... -.7...� - -- '-:..._. ...................................•-------- ` -- I.9-Ti --------•--•---•-------•--- �:. ....._....._ Final Inspection by: .. . Date r --- --- M SAN JOAQUIN LOCAL HEALTH DISTRICT 7 X79 'A M