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FOR ©FFICE.USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit Na. ....7y........: •...... Pe .... . ........... This rmit Expires 1 Year From Date Issued Date 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 with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION :.92_.._claGi......._•=-_-° _ CENSUS TRACT ... . ....................... Owner's Name ....fit-?.Q� R� ......_ ....---•-----•--.........•--•........... ...... ........ .........:.........Phone Address `� -�, �.. a ...__� u?.. ..... ..... .... City .. t4 .. ..._... Contractor's Name �� .A.�...Q ►2 tSk�_. �1 X0!.1. ............. • ._...License # . ... _~ .`. 3.. Phone Installation will serve: Residence ®'Apartment House❑ Commercial ❑Troller Court 0 � Motel ❑Other ............................ ...:........_._ Number of living units:_..-/.------ Number of bedrooms ---a-----Garbage Grinder ............ Lot Size ................ Water Supply: Public System and name ----------------------------•--•-••--.-.-----••------------_--_- - -------.......---- ---• •...Private ----- ----- Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay []r Peat-171 Sandy Loam 0 Clay Loam ❑ � s �IIY�r..-_.r i.il... w•.�m�r.w�s.. -- __ .� _ _ ' Hard y`an -1 Adobe' P ❑ ❑"_.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 ov ilable within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK[ ] Size..................................... .......... Liquid Depth ................... Capacity .................... Type JL . Materia(---_----- ----- .. No. Compartments .................:.... Distance to nearest: Well . ............................Foundation ...._.•..._....__.... Prop. Line .... ............ LEACHING LINE No. of lines gth of each line._.___ Total Length r� �. ...................... -•--........ ....._... •--••--- .._......_..---tD 'D' Box .......___•- Type Filter rial ....................Depth Filt Material ._......................................... ,6 Distance to nearest: Well .... ............. Foundation ..._._.... .._...._.._-. Property Line ._............_.I....... SEEPAGE PIT [ ) Depth Diamete -•----........ Number .............• - Rock Filled Yes ❑ NoWater Table Depth ..Rock Size . ..Distance to nearest: Well Foundati Prop. Line ........._..._REPAIR/ADDITION(Prev. Sanitation hermit�# ............. .................. .. Date ....___V__......_._.....__) C t Septic Tank (Specify Requirementsl .________________._..........._....__......._ .................................... Disposal Field (Specify Requirements) ..f ...�:.tN -•-••--••-_- r ......................................... ....................••--..........•---------------------------..............---••---...-------- ........ -....�.. 7.. ., -- (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. 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 a ame subject to Workman's Compensation laws of California." Signed ----------------" ......-• - ---. ............ ................. Owner BY V--e= _ . 3itle c 5^(`. (If her than owner) FOR DEPARTMENT USE ONLY Q APPLICATION ACCEPTED BY ....�a R o.---------------•...----•-•..........-•..................................... DATE -•-.• f`..�� .`. ........_.... -- BUILDING PERMIT ISSUED ...........................- ------•-•.:.......................-.._._.-•..............:.._:..............DATE ..----•---.. .............. ......... ADDITIONALCOMMENTS ................ ... ................ --- ................................................. ...•••--•------------------ .......... ....---------• .....--------------------- ..........-................................-............................... , ................................. = ..... ... ._ ....--- -----------------.................. ---------------------------------• •---------- - ---• ....... . . .. .... .-•--- Final Inspectio ---- •... --- t...................................Date . �,:r...�. _... . SAN JOAQUIN LOCAL HEALTH DISTRICT C u 13 24., -tee n_.. rAA -� !-,n 4 •�