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FOR OFFICE uSE: APPLICATION FOR SANITATION PERMIT �• Permit No.7........��P2 (Complete In Triplicate) ......................................................... This Date Issued .................... Permit Expires 1 Year From Date issued 02-1— 166 --1 e Application is hereby made to the San Joaquin Local Health biatrict'for a permit to construct and install the work herein �. described. This application As made Irl compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION. Yltr/A41_ .�4�ts .hl .Ow.?Yjst +.G4�t �!6 .-.• 4��4!�R.CENSUS TRACT .......................... Owner's Name ..� G(..Lg•......."t _4 Phare ............................ Address .......V.....0. -. ...".]5............................................ City :.:..:................................. /' ................ Contractor's Name .. �• ✓ "...�..................License # �'�3. a-...:. Phone .............................. Installation will serve: Residence(!rApartment House❑ Commercial OTraller Court 0 Motel 0 Other ..................................--........ Number of living units:...... ..... Number of bedrooms ........Garbage Grinder ............ Lot Size ...4�r� Water Supply: Public System and name ......................................................._......._..........................................Private 0? Character of soil to a depth of 3 feet: Sand 0 .Silt 0 Clay Lr]' Peat❑ Sandy Loam 0 Clay Loam 0 Hardpan 0 Adobe 0 Fill Material ............ If yes,type ............................ (plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side.) NEW INSTALLATION: (No septic tank or see age pit permitted if public sewer is available within 200 feet,) i PACKAGE TREATMENT ( ) SEPTIC TANK Size.. �a��){..�.�.Jl.- .1............. Liquid Depth ... ..................... Capacity .�'�q.P.41ff Type ....... . . ... Material--- g,,-. No. Compartments ....2................ Distance to nearest: Well ...........010_a-----------Foundation ......10. .. Prop. Liner...--...... LEACHING LINE [ No. of Lines -------.3--- ........ Length ofeach line..... p.-.�....... Total Length ../w'�.[d. -.._•� •D' Box ...-J .... Type Filter Material .......Sr4 1'. . Depth Filter Material ....J-y............. ..- ...... �/ Distance to nearest: Well .....4�). .. Foundation -----l.fi.1i.fi:----- Property Line .......5�...... SEEPAGE PIT [yl Depth --.. -r Diameter 42 Number .........3............... Rock Filled Yes [3"*' No 0 . . Water Table Depth ... Rock Size.......�D.0 ....I.......... ... / ..r^}..r......... Distance to nearest: Well ........f ffJ9.�.d ----------------Foundation ....fQ.pt.... Prop. line .....ml ..--t REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ................................A SepticTank (Specify Requirements)`.............................................................•............................................_............._............--.•. DisposalField (Specify Requirements) ..........................••.......................................................................................•................. ................................................................................................._......................._............................_.................. ......--...................-- .................................................................................. .................._.. ----..............•........................ -- (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 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, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed .................................. .. ........ :. Owner _ By .......................................etiGwsAa(•..-(J!.••�� @ ..... ------ Title .�fn^ /IR.F? +f�...................................... . (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. .. ....... . .. ..................,............................................. DATE ..9. �6..:. r.......... BUILDINGPERMIT ISSUED ......v....................................................:.•.._...............-........I..... ....DATE......................:...:...•............ ADDITIONALCOMMENTS .................................................................._.................-.-.--.....----.................-...............--........--.......--..... ..................................:...•.:._.......................... ..:..............:-...........•........................:......................._......_.................................. ..................................................................................................._............................................. .................................... ..L1:...rl!:.....:......•. ..... ..e/........................................................................ ..... ...{ _......._._.-. FinalInspection by: c �C ... .. . .......................:.....................................................Date .. ..:j --T .................-. SAN JOAQUIN •LOCAL HEALTH DISTRICT