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FOR OFFICE USE- APPLICATION FOR SANITATION PERMIT 7 ..71��. (Complete In Triplicate) Permit No. . �. L ............... This Permit Expires I Year From Date Issued Hate Issued ................ k Application is hereby made to the San Joaquin Local Health District for a permit ta nstruct and Install the work herein described. This applicatio mpIigrJce�uvith unty Ordinance No. 549 and existing Rules and Regulations: u��ff''�k ( ,TOB ADDRESS/LOCATION /id_...../vl ±a.. „CENSUS,TRACT '..,.... I Owner's No ``.' t' s }.._' G ..� _L ............... ............^' ......... Phone - _ _ .............. Address . . -?:. 7. _..�Gti-1iTcrl?.t.�.._.s7`....%�► G?.e-r City: .�,, ' ov. - .... ............................................._.._ frr�s /i Contractor's Nome.�.........................�`..., d:y�...............:.- License # .e"I- ..v . !,3... Phone ..` F: .`�.O. l.... F Installation will serve: _ Residence[spa finent House❑ Commercial❑Tra€ler Court C] F . ,a , �� Motel ❑Other................. : ....................... j .� <... 1 Y f � J C ':S Number o#living units:--~..�:.__ Number of bedrooms __.. .!-.Garbage Grinder ....1...::. Lot Size .................... .:.. ... ...... t Water Supply: Public System and'name i .....................:.......: ..............................................................................Private Q" + Character of soil to a depth of 3 feet: Sand Er Silt❑ . Clay ❑ Peat❑ • Sandy Loam ❑. Clay Loam ❑ Hardpan[j Adobe-❑ Fill Material ............ If yes,type ............... ............ (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 feet,) PACKAGE TREATMENT j ] SEPTIC TA14K ] Size...Y.,AO- r_.__.6.:16V.�5(°:...__ Liquid Depth .....z.Y...:............� Capacity Type - Material No. Compartments ..:...z-. 6 Distance to nearest: Well ....ate®..fi --•..................Foundation ..... Prop. Line ................. LEACHING LINE ( ] No. of Lines ......,3................ Length of each line...... --- ...... Total length 'D' Box .... Filter Material / .. ...Depth .Filter Material Distance to nearest: Well ...... .p �F". Foundation _._: Property- ....... fi� nn SEEPAGE AT [ ] Depth .................... Diameter :._............_ Number ............................ Rock Filled Yes ❑ No Q V' Water Table Depth _--------_--------_-- .....................Rock Size ................................ 0 ri\ Ic . Distance to nearest: Well Foundation Prop. Line ................ REPAIR/ADDIIION(Prev. Sanitation Permit# .-..:--.._.:................................ Date Septic Tank (Specify Requirements). l _ __ _ r DDisposal Field (Specify Requirements) ................................................................................. (Draw existing and required addition on reverse side) I 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. Hams owner or Been- sed agents signature certifies the following: "I certify thcit in the performance of the work for which this permit is issued, I shall not employ any person In such manner as to become subject to Workman's Compensation laws of California." Signed - ......•------ ------ ------------------------------------------•-----.........•......... •-•--- Owner BY - -------------------------------------•-----•-•------------------ .._._ Yitle .....mss.. '-/✓N_c:-, --........... ........ f lit other than owner) FOR- DEPARTMENT USE ONLY^, APPLICATION ACCEPTED BY ... :; _ DATE . .�.. .:`. _�........ BUILDING PERMIT ISSUED - ----------------_------------ DATE....... ......_....._. ADDITIONAL COMMENTS ------ ----- -------------------•--.... - --..._.._.._•---•- ..----..._.. - ..................- :... f ------ --------- ------------•---------•--..__...------------------------..-.. final Inspection by: _. ------.____- - -. ........ ............................... `~ ..__._.. __ ......_.._ ! EH 1.3 24 1:-6 3 ltev. � SAN JOAQUIN L CAL HEALTH DISTRICT 8�7h 3M