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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ......... Permit No. :...................................................... (Complete in Triplicate) This Permit Expires 1 Year from Date Issued Dote Issued 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 co lion a wit unt Ordinance o, 549 and existing-Rules and Regulations: # PP ��,..� � y r JOB ADDRESS/LOCATION ...............CENSUS..TRACT s`S Owner's Name .J �: `... .j. ...:. A.. .��. .-�.} ••1 ...., �a. ..w_.Phone .............. .................... Address City 1:3 -. _ E Dei/ Contractor's Name ..—J. a- ppp '�-� .�.......................:........License # �I ..Phone i Installation will serve: ReOclence-CT-xp—artment Housed Commercial C]Trailer Court ❑ �Moiehq Other ... .......... Number of living units:._._-� g ' S'Lr � �-� ....... ` - S S Water Supply: Public System and mime :........ _.. N�er. t Size .. ( ...Private ®� r.. Number o bedrooms arae r n Character of soil to a depth of 3 feet::- Sand r a t p .. . � ` t �arn�❑ C�ay�Loam P ❑ Slit❑ Clay ❑' Peat❑ 3�.sandy Lo Hard an ❑ Adobe '❑ Fill Material �... if yes,type ...__ ._-__--_-- _ . (Plot .plan, showing size of lot, location of.system in .relation 'to wells, buildings, etc.;must .be .piaced on reverse side.) U NEW'INSTALLATIONt (No septic tank or seep a pit permitted if pub(#c sewer is ovaiidble within 200 feet,) '4 PACKAGE TREATMENT ['] SEPTIC TANK [ Size.. : Q- . . ..... LiquidjDepth J.. ....r.. ... pe . Com, Capacity ments . ....... 1 istance to nearest Well �^ �� ........Founds ion .... .�. ...........�tProp. Line. ......... LEACHING LINE [ No. of Lines ..._ �!' Length cf 4o' LEACHING `. Total "Length � � ..y.. ....... . ,. r 'D' Box/�T e Iter Materal .R.�::Deipth Filter rMaterial ..../ ... ............ .................. Distance-10 nearest: Well .A(9............. Foundation ....��... f.... Property Line ..�............ {SEEP,AGE.PIT [ ] Dep -----------. Diameter Number .................. . Rock Filled Yes ❑ No --W:4VWater Table-Depth.::_::-->:- .I-Roc-k Size ..... .................... Distance to nearest:'WeH +�* s ..:.. ...:..... „Fou dafifon- ................ Prop Line ............... f REPAIR/ADDITION(Prev. Sanitation Permit ............. Dotes..................................I .... ...._........:........ Septic Tank (Specify Requirements) ---..._�--------------------------•-----...............�...-:......................................... �i....�..�.._. Disposal Field (Specify Requirements) ------- .. .... ......................................................._.............................. ....... --------------............................................:....................... ............. .................... ....................................... :......._:... ......................... (Draw existing and required addition on reverse side) � I hereby certify that I have prepared this application asci that the work will be done in accordance ith San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health Disteld.}Honkie owner or licew sed agents signature certifies the following: f # "I certify that in t e performance of the work for which this permit is issued, I shall not emplo anyperson in such manner f as to beco . . sub ct m n' omperisation laws,of California:'' ' Signed ._... .� c.. ................................::...::: Owner. - !P B ...................... ...................................... -_�... tie .::. :..........`...:.......:: ...... I By t�. �i (If other than owner) p ru FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ..�L....e.. ............ •----• = .............. DATE ....��:�/.`.�..� k BUILDING PERMIT ISSUED . DATE . ' ' ...........:............................•-----.......---=......---=--...::..:...:........ ADDITIONALCOMMENTS .......:... ................ ............................................ ' --.... '.:'` } .._.............. ......... :........................................ � ..�r,:...•.” ........................ Final inspection , r4. _ ` ,�. t i r °I7�te ., :_~ �•_ ;SAN .JOAQUIN`LOCAL',�HEALTH,,,DISTRICT,t E. H.13 24j-'68 Rev. 5M 7172 3 M