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.........ff•'/i-- - - ------------ ------ 2 APPLICATION FOR SANITATION PERMIT ......... ............... .•----.. .._.. .. (ate in Triplicate) Permit No. 2............. CJS A........................................... This Permit Expires 1 Year From Date Issued Date Issued .l--�: :7) pplication is hereby made to the San Joaquin Local Health District for a ermit to construct and described. This application is made in cl the work h ompliance with County Ordinance No. 549 and existing Rules Instand Regulat onsrein } JOB ADDRESS/LOCATION Ta- � - �TF/VG(J L ..............0 Owner's Name ...,_ .. ._. E _ ----------•- hone ...... � ........_.. CT Address . ��-�,� � p '--• 8- ._...._�:rl� a. City �•u? �`-� Contractor' ..... ........... City - Contractor's Name _.. _._ 1 License # . Z(.... Phone � Installation will serve: Residence(Apartment House Commercial❑Trainer Court ] Motel 0 Other Number of living units:............ Number of bedrooms .._1.--..Garbage Grinder ............ Lot Size ....�� .--.Qk"O,. .............. Water Supply, Public System and name __................................. . - ................. ..Private (� -- Character of soil toa depth of 3 feet: Sand❑ Silt❑ Cloy ❑ Peat❑ Sandy Loam 0 Clay Loans a" Hardpan Adobe p ❑ ❑ Fill Material ............ If yes,type .......:....... .... {plot pian, showing size of lot, location of system in relation to welts, buildings, etc, must be placed on reverse aid NEW 1NSTAuarioN: (No septic tank or seepage pit permitted If public sewer is available within 240 feet) PACKAGE TREATMENT [ I SEPTIC TANK SizB Capacity 5 '� Liquid Depth P ty 4Z T YPe` _ to Material-_ -------- No. Compartments Distance to nearest: Well/A.0 ...... Foundation Ab.� Sb Prop. Line ........ .. - .. LEACHING LINE No. of Lines ---- ---------------- Length/of each line...... --- ------. Total Length ...�.�P... 'D' Box ..- --:----- Type Filter Mater'na'l .. ..._---.....Depth Filter Material ...--_�[_.11-.- ' .......................... 5uW E Distance to nearest: Well _. _:L -.-- Foundation SUIZA Depth __•--------••-__-_-. Diameter Wd.............. Property Line ..SO... . -,.r._---T E3J ---------------- Numbers..___-.._...__...__.._ .__.. Rock Filled Yes ❑ N X Water Table Depth ............... Rock Size -....---•••• Distance to,nearest: Well ------------_............................Foundation ---••-- ............ Prop. Line ..................... REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ------------•-- - Septic Tank (Specify Requirements) ___----------------------------- --•---.......•-- isposal Field (Specify Requirements). ......................... --------------------------------------- ........ ......... ' k ---------------- (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 Sten Joaquin County Ordinances, State laws, and Rules,and Regulations.of the San Joaquin Local Health:District, Home owner or Ilcen- sed agents signature certifies the following: -4� "I certify that in the performance of the work for which this permiit.is Issued, I shall not employ any person In such manner as to become subject tojW rkman's Compensation laws of California." SignedY! °,. . B �'~Ow.nerr Y --------------------------------------------------------- Yitle ... '~ (if other than owner) # - . FO DEPARTMENT E O APPLICATION ACCEPTED BY �� _. .---- BUILDI.NG'-PERMIT ISSUED t DATE ADDITfONAL COMMENTS ------------ •----- •-•--------- ------ --DATE ................-_ = �- _ -J s * .............._ __... ___________________________•- ................................................................................................... ___________________________________ _ _ ............. .. ............................................................ ......................... Final Inspection by: _. ._ _ • - EH 13 2h 1-613 Rev. -� - ----- ------------••-------....--- -• -- --- -_.... ._...._.... ._ -.. _...._Date ... ...-..�J_-..-�.7..--------...._... SAN JOAQUIN LOCAL HIALTN DISTRICT 8/7h 3M