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FOR OFFICE: USE: APPLICATION FOR SANITATION PERMIT 7 ��7� ......:....... ................................... Permit No. _.._... 1..... IComplete in Triplicate) ................................ ................... This Permit Expires 1 Year From Date Issued Date Issued ZIJ_:�.226 Application is hereby made to the San Joaquin Local Health District for a permit to conrstructand install the work herein described. This application is made in compliance with County Ordinance 'No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION uF'.E? ....G°LL :Zc-tree. -re CENSUS TRACT _.._.:..-•_- Owner's Name �l�rn �.. -i: �' - � .c�1,ei ..�. 1 Phone,. ' l- Address . ..... . . �'.�2:! . :, ... �-- ity. ... . . - r Contractor's Nome :. :_._.. ''?'t!!{..... . 'r}' - ✓ ° - � ::License # { �� f "x Phone ; .._ f [_Ap irnent House,Q Commercial-E]Trailer-Court: ❑, i Installation will serve: RQsidence art i Motel,❑ Other—L.'i Number of living uniis:_>,,, __,.:;..Number of;bedrooms... _•.G4rbage.,Grinder Lot Size. i' Water Supply. Public System and name ._... ;... ...... Private . Character of soil to a depth of 3 feet: Sand 0: Silt❑ Clay ❑ Peat ❑ Sandy Loam,❑ Clay Loam; l Hardpan ❑ ❑ f:ye ,'type _.. " ........... ardpa Adobe Fill Mpfierial I _s (Plot planshowin'g. size, of..fot,..lo a•t.ion...ofsystem`;..in.:re.lotion,to...wells,..bu ldin'gs,. 'etc.. must..be..p.l6ced on reverse :sided NEW INSTALLATION: INo septic tank or seepage pit permitted if..publie sewer:is available:with 200 feet,} PACKAGE:TREATMENT ( ], SEPTIC TANK G Size45_41A.—_.___ -.47.....:......:...... Liquid Depth Capacity . �o.G' 7ype - ` Mpteriol.. _ 'L- .- `No. Compartments ------.. ...... Distance to nearest: Well .Foundation Prop, Line;. �' . . ... LEACHING LINE / "N". . of: Lines L6n th of each line 'dotal Len th �_?--�_�.. E►7 =Jti.. i - 9 I D'"BOX ....: l"' °' Type'Filter'Mater�ol" ::Depih Filter�-Ma#erial /.f%... .. ... ... ..... k ' r Distance°to necsrest Well ::::'::: tr _ " Fourrdati�on Property`Lir}e•:S_0. ._...-R. SEEPAGE PIT `{ / -Depth . ;• DiQmeter- .. Number :. Rock Filled Yes NO,10 Water Table.Dept.h ...__. .. L j' w _.. Rock.Size ; Distance.ta;nearest: Well„ ��. _-, Foundcition _-;..'�17 -lT. . Prop.,line �._r ''� .., �. REPAIR/ADDITION IPrev. Sgnita#ion;:Permit # Date.. ) I 'Septic Tank (Specify :Requirements) ...... ------ ...... . 'Disposal Field {Specify Requirements) ..:..-.-.:_ ------------------- ------------------ .. __. _ .. ' --- ---------------- --- ---- } , I .. 1 „(Drq'w 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 5dn Joaquin local Health District. Home ewnar ar liien sed agents signature certifies the following: ;.. . :. :. ... :.. .,. "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's.Ciimpensafi'on-laws aF CaliforriiiL" ' , , Signed � ....... . ..... ...---- .:- •- -� '..�._ ner ' - ---.--.--- By _-. _ -. .. . . �.: .,,(� ' t: Ole .. (if other than owner) ; • � ,.. . R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ... DATE BUILDING PERMIT ISSUED . __..._.. . . _. .._...._ DAT: .. . .................................... ADDITIONAL ADDIITIONAL COMMENTS ................. ..... .....: ..............:... _ .._ ........................... . ..._..--- / . _ ....._ _ Final Inspection by: C.:.-- /Ez. .-*-_ r ------.._...._Date . ^.. .�. .. �. .�.., SAN JOAQUIN LOCAL HEALTH DISTRICT