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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT ................ 7 `/a E .......... ............ ......... (Complete in Triplicate) / Permit No. .................. >•••••-••-•--•- • .---...--=- •..••................... This Permit Expires 1 Year From bate Issued Date Issued .1.�'.a .. i Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work here described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCA N ........., .. 3 ..... 7 7Z�' t ._ ..CENSUS TRACT ..............•........ . ......... . Owner's Name a. . <<tY �2?�'4-- _ .......................'tib.....-... ......: - ... Phone I�:"/- -P Address .. = Contractor's Nome . ._ .___. . . .......License3..... Phone`s ??147..... Installation will serve: Rd'sidenceyApartment-House•❑-Commercial-❑Trailer Court-❑— -- ~-- Mote! [] Other .............. ..................:......... Water Supply: Public System and name z... .... ........ - �.. mot-SizefC.1.: ............. Number of living units:. Number of bedrooms...... .__. ..Garbo a Gander :. L-�� ��`'`:----`"-. ..v�..__.,--.Private ❑ Character of soil to a depth of 3 feet: Sand ❑ `SiltQ Clay El "ilPeat.Q Sandy„Lo ma Clay Loam p Hardpan f,Lg Adobe Fill Material _.._ - If yes, type ............. (Plot plan, showing size of lot, location of system in °relation,rtb�ls, buildings, etc. must be placed on reverse sidt �. NEW INSTALLATION: (No septic tocik-.or seepage pitpermitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( ] SEP IAC T Kk 1�] � Size --------------__ ....................... ----- Liquid Depth ....................... CopacftyType ..- Material---I......:......:.... No. Compartments Distance to nearest: Well •F Mundation,._� . .... .. Prop'.ner-�_.__..._•.._ LEACHING LINE { ] No. of.Lines length of each line Total Length ._ De:. ... ... ........... ....... Q d3dx Type Filter Material ..... __.:..._. pt Fi tel�i"Material"'. - - �. --- r=:...... DaStdnce to nearest: Well ...............:......_ Foundation Property Line .:._ ................. SEEPAGE PIT [ ] . ' 'ne th t Diameter `_.._.__..__.. : Number r Rock Filled Yes�q /No I d Water Table DepThy.......:..........:..............j---•-:-.......Rook Size .- _._.... _:... ro h D;stance to nearer ;,Well .,,_-._...__.x�, _�.,lL....:........Fo9unddfion. p-i'ne .._..... ._ REPAIR/ADDITION(Prev. Sanitation iPer it# ...........:...... ............�........ .... -Date ................................ ..........6 }} I Septic Tank (Specify Requirements) Disposal Field (Specify Requirements) -�- t-: ,.--� ^z.. .......... ........ M (Draw existing:and_required.addition on reverse side) Z I hereby certify that I have prepared this application and tbatl the work will be done in acro dance with San Joaqui County Ordinances, State Laws, onkd Rules and Regulations of the San.,Joaquin Local Health Distract. Home owner or licei sed agents signature certifies the following: ' "I certify that in the performance of the work for which thgs pe?mit ii issued, I shall not employ any person in such mann as to become subject to Workman's]Compensation IiVws ofJCalifornia." ` Signed _ _.�. _.... ... A . Owner BY 41fof er n owner _ Title-. ....C"u�l................. _. ................... ) � I � FOR DEPARTMENT USE ONLY ►�` —� --- ---- --- -_ _ _— APPLICATION ACCEPTED BY . . _ .._...._ .... ................. DATE ........ ...-.......-•-7...:r......._. BUILDINGPERMIT ISSUED .................. ...................--..._-..--••-----.....----••--•--.-----.......:... ...._......,..DATE ........................... .�........ ADDITIONALCOMMENTS ..................• ................--••-•--•---......... ::....._.................... _ ..............----------------------- �. -..:....-�,_........i. ...._.. - - / ....... ............ . ..... -- ... _. ./ /.. Final Inspection by t� Date ••••••-- fr ,SA JOAQUtN LCAL HEALTH DISTRICT