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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ...........................................I..._.... Permit No. .23.�G � l (Complete in Triplicate) ._......................................................._. .............•. This Permit Expires 1 Year From Date Issued Date Issued ...7:1:�.. 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 ......:�� .y .. .:- �''-s... CENSUS TRACT t Owner's Name ................ .. .................................r.............. �J........ Address ............. ------230�t 1 _ ---- ........... City -..A,_w,)��_...L��'.�........----•---••---- •--.......... Contractor's Name ............. . ....................:.`.License # `f 3 �''..... Phone .. .(:.Kn Z... Installation will serve: r--' -Residence-❑-Apartment-House-Q,Commercial�E]Troiler Court- Motel ourt t�t'Com Motel ❑ Other . p°! '_ 5; _ Number of living units:..__"�.__._ Number of bedrooms 3.......Garbage Grinder—, ._ ....,Lot Size i/. ... . Z �.............. Water Supply: Public System and name ................••---•.•........_.............___. .....:....:.y.._._..---...---...............Private 2q Character of soil to a depth of 3 feet: Sand 1:] Silt❑ Clay ' Peat❑��w Sandy loam ❑ Clay Loam Q Hardpan C:) Adobe'C] Fill Materia( ---- -_-•--- If yes,type ---------------•-..._-_`'_... (Plot plan, showing size of lot, location ofsystem in relation to wells, buildings, etcl must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted ifLpublic {ewer is available within 200 feet, ' „} ='� �: .._ .. .. .......... Li uid De th-' ...S-- .....?5:�...-. PACKAGE TREATMENT ( ] SEPTIC TANK[ ] Size.. '--•--- - R� q P / Capacity ..j!Z,�� Type . .!° :L'� .:Material.__ al- ? No. Compartments Distance to nearest: Well I -Foundation .___._� Prop. line S --...�..._ 7 ar.. i LEACHING LINE ( ] No. of lines :...... ............. Length fof a ch line.____?Q...__.._._._... Total Length -7CQ"....._....... 'D' Box k� Type Filter Material' --.Depth Filter Material ._ _ ........... ................. Distance to nearest: Wel( ...... ."_ _ __ Foundation ,�.�- ...... Property Line ..x7.. ............ ...... .. SEEPAGE PIT ( 1 iDepth Diameter ... Number ............................ Rock Filled Yes ❑ No C ;E Water Table Depth ....:.......Rock Size Distance to nearest: Well ... p. Foundation Pro Line ' 'F REPAIR/ADDITION(Prey Sanitation Permit# ..........,...................... _... Date ..................-------_------11 Septic Tank (Specify Requirements) ......------• Disposal Field (Specify Requirements) ----------- - ---- 4 _ ............ ......f..---t-•-----------••-•-•..._.._..-•---........................._..-----._.----------------•--- I -----•........................................................................................... ... ... .......................................I--_.....__....... t .......................... ............................. .........•..................................._..............................................__.....................-_. ---•---._-- (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 li 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, l shall not employ any person In such manner as to become subject to Work an's Compensation laws of California." . Signed Owner ` --•.................................... -- . .. ......... . ........... .Title$y ......... 'A'Al : ... (if other than owner) r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ... ..... .. . .................... .... DATE .......`.�. ..ID_ ....3... BUILDING PERMIT ISSUED ... .... ...........................................................•-•------••----•-----•---...........DATE .................................... ADDITIONALCOMMENTS .......-•...................................•---••--••-•--......---..........__.... ...........-•---.........•---...__..............---- ---...._._.._......_ ..........................................................:..........:................•....................-..............................................................-.............. ......... ................ Final inspection by: Date 11,51.9,3 ............. ..... SAN JOA UIN LOCAL HEALTH DISTRICT 7/723M