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FOR OFFICE USE: kAICATION FOR SANITATION PERIV Permit No. ........... (Complete in Triplicate) ... ................... .......I..........La = ':Z.. .......................... This Permit Expires ] Year From Data Issued Date Issued ..s ' " plication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein scribed. This application is made In compliance with County Ordinance No. 549 and existing Rules and Regulations- Up egulations:U JOB ADDRESS/LOCATION . ...._.____... _ .1...r....... T ........CENSUS TRACT .......................... iwner s Name -c .._4-lee. .X.L.t------••-:••-•-••- Phone _/.:_c2`�y .�,. ..... _. Lddress ................- 1 - --._........--••--•--:'......----------•-•-----....... City -- t��G /t? 71r rte......_.._...----•- _....--•- "ontractor's Name --.".- -f' r.---•--�C. _Z G�'�. .......................License #�.r�'c�...��. Phone stallotion will serve:' Residence [Apartment House❑ Commercial ❑Trailer Court 0 Motel ❑Other ------------•--•--- .................... Z �.. 'V lumber of living units:---- Number of bedrooms ._.� ...Garbage Grinder .._.....___- Lot Size ..._`. ...................................... r- ater Supply: Public System and name ---------------------------------•...._............_. ........................................................Private 'horacter of soil to a depth of 3 feet: Sand❑ . Silt E] ClayX Peat❑ Sandy Loom {] Clay Loam E]L Hardpan ❑ Adobe [] Fill Material ............ If yes,type ............................ L'Not plan, showing size of lot, location ofsystem in relation to wells, buildings, etc, must be placed on reverse side.) IEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) Z - PACKAGE TREATMENT [ ] SEPTIC TANK size..Z.- ��__6................. LiquidDepth .....67--.7....... ._ _....------ TYPe .. ` Material No. Come artments ............. 44 Capacity Distance to nearest: Well _..._ ......:.................Faundallon . G ...'_.------ Prop. Line ...................... i . 'EACHING LINE [ ] No. of Lines .. ......:::........ Length of each line._._. 's _._........... Total Length ......._____- 'D' Box __1 Type Filtee""Material i/�.��.Depth Filter Material .../..�.. Distance stan _ ..::.-. . ce to nearest: Wel( ....................-5.. Foundation _..--.-•---.. .......... Property Line --•--•--•-• -•---.....__ P.6 ________________:Rock. Filled Yes [� No [,�EPAGE PIT [ } Depth a`. ....-_..-_ Diameter _..._. Number __. ___. ❑ I Water Table Depth .......Rock Size ................................ Distance to nearest: Well........ ..........:...................Foundation ..................... Prop., Line .-.-..__-----.------- L;EPAIR/ADDITION(Prev. Sanitation Permit# { ..._-.......--•------ ........................ Date ............-_--------_-_------ Septic ------------•-•---- -Septic Tank (Specify Requirements} .................................•-----------------------•----------.......- ---•-------•----•---._.__ ........ .......... Disposal Field (Specify Requirements} --•-•--------------• -•-•------•----•-----------------•--- ---.........--------•....---•....--- --••---•-...----.......-_ ---------- ----•---•--------•---- ................................... •-•- ••---•-•----••--------------- .................................... -......................... (Draw existing and required addition on reverse side) 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 liven- ed 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 become sVbl!tq to Workman's Compensation laws of California." igned f �.....�... r,�t - -----------------------•------... .......... Owner. ...... Title ..................................................... ilf other than owner) 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPT BY _... =--- ------------------------------------=--------------•-••-----.... DATE _BUILDING PERMIT ISSUED . .. .DATE -•-- ADDITIONAL COMMENTS ........................................,.............. .....:- ............. - ................... ---------------- •---------- ---._.....---- -••••••-••............ .. ------------..................................-------------•-••---.:........................... ........................ ......-•-•--••-----------........---•---=-----;..... .• -------•---•-••--------- -----------------------...................................•---••........ Inspection by: ...:....r :.- • .. ..... . • .Date �_? .............................. SAN JOAQUIN LOCAL HEALTH DISTRICT