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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. .JY........... .............................. ......-.........--_..... F .. � y ••-' (Complete In Triplicate) :...............................................Y.... Date Issued 5 This Permit Expires 'I Year From Date Issued I Application is hereby-mode to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulation: .....CENSUS TRACT JOB ADDRESS/LOCATION ....17 ...._,. u.._..Vrn '-1. ..................................... :.._. Name I ; .�. ......tft......e.U�.��5 . ... Prone Owner's sL _ I .. Address ..._..... _ 3` ...... ''_.._..`c :41: L� � ........................... City Iv ......_................_._................ Contractor's Name =IAS..... . ,.L 71` license # ........ Phone ............. -------------------- -r.... ... Installation will serve'--' Residence e Apartment Hous [] Commercial QTroiler Court fl i.: Motel Q Other _ /P t�-I t i�-1� ��i--.--- Number of living units:....... .... Number of bedrooms ..�-.�-......Garbage Grinder lY....._. Lot Size .. . ............ •••-••• Water Supply: Public System and name ... °i ....................•--.........-.__.......Private r ' o depth of 3 feet: - Sand Silt CIO Peat Q Sandy loom 0 Clay Loam Character of sail tbo de . a : - Y Hardpan Er Adobe Q FIll Material ...lY..l7_ If yes,type ............................ {Plot pian, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: lNo septic tank or seeps a pit permitted if public sewer is available within 200 feet,) If 'L'iquid Depth ._._� •..-••••••- PACKAGE TREATMENT C ] SEPTIC TANK,1 -- Size..... ....._.I...............................r Capacity :I ��----- Type C0$7.-- Material SP C 1�7o. Compartments ........ -- ---, i Distance to nearest: We .....J�.i"+..........�...Foundation `(_0,,,,.,.;•�. Prop. line ..................... �.. 4 �� ► LEACHING LINE [A' No. of Lines _.....�............... Length of each line..... Total,�aenpgth f.,7 ,,� --- 'D'Boxi ��. Type-Filter Material ®C Depth fFllter�Material .:.. _/...:..................f 7 ' • - I Property Line Distance to nearest:-Wel -.. Foundation . ..----•--...`-......_ SEEPAGE PIT (Al Depth . "� ...._.... Diamet®r � .0...� Number .... ............ Rock Filled_-Yes No Water-Table- Depth _�..�I..._-- ..............Rock Size�� r- f ;# -- r -f' LP Distance to nearest: Well ..._...IQ .--.--�..._.....Foundat€on .. ........... Prop. line ..................... i . s : REPAIR/ADDITION(Prev. Sanitation Permit# _...---•..._:_..--•--...f_-_._•-••----...._. Date ..............:................... ) Septic Tank {Specify Requirements) r..................#---•-------...-•---.... .......... ._..... ....... -- ......... -_ - Disposal Field {Specify Requirements) .......................................................A!•.... ................. < ... !ti ......I.............. --•--.:.............................................•--...----- _......--------.......---•------..........._ - Y Draw exist. . and required addition on•.. ---:................................... I g '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. Homo owner or Hcen- sed agents sI natu certifies the following: "I certify tha in t perfor an he for which this permit is issued, I shall not omploy any person in such manner as to beco sub ct to W k s Co cation laws of California." Signed _ ...... - . Owner B .... ................. Title ..... ` llf other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ..__ . . ....:..... ..-:--:--.-... x..... . -' -_:..:.:..........::......:......:.:..:..:............. DATE .. '�.� i3U1WING PERMIT ISSUED - ; .ti = { 4..-...... .0. \ DATE ..................... ADDITIONAL .COMMENTS :..-..........:...:............:..:....-. ..........................................._........... ........................................ . ......................................_........ ...... ........... �_. 4. . .. i Final Inspection by: .....Date .. ...... ........ ..... SAN JOAQUIN -LOCAL HEXLTH DISTRICT 7/723 X