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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - ------ � (Complete in Triplicate) Permit No. ...7j7/ ••� Triplicate) _ • ..........I---- - ------ .............................. Date Issued .3.�.X C ..:---_---_-------_........_-_..................... This Permit Expires 1 Year From Date 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 compliance with County Ordinance Na. 549 and existing Rules and Regulations: JOB ADDRESS/1-0 TION .�� '2/ p - ---- rsr"' - CENSUS TRACT ......YJ............. Owner's Name/y►�rA'kf/CMl.• .. S.Q'�.-......... •.. ....,... Phone ... Address -------6.0- - i --- -- - --��... . ......... City -------Q` +T -r...._._.......----......................-•...... Contractor's Name .-..4w./I -... .- - ----- -- . '.License .��! . .1'.yPhone ....--------- ................ Installation will serve: Residence❑Apartment House❑ Commercial ElTrailer Court ❑• Motel ❑Other Number of living units:.......... Number of bedrooms .._..Garbage Grinder ............ Lot Size Water Supply: Public System and name ......................._............................... ......._..........................................Private _ . -Character-of,soil-to_o depth of 3 feet- ,.Sand t]�SiI� Clay.;]]_Peott❑ Sandy Loam Clay,Loom,❑_ Hardpan ❑ Adobe O Fil(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.) E NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK Size ...X. .---- _ Liquid Depth ... .................. )^^ -- , Capacity ..la _761 Type .._.___ ___..._. MateriaL__Ll._ No.. Compartments _e�...�...-•..._. / Distance to nearest -Well ---------- ....................Foundations__ ........... Prop. Line ....... . LEACHING LINE [ ] No. of Lines -----/....... ......... Length of each line......, .......... Total Length ..94.._.......... 'D' Box �----- Type Filter Materia( -----Depth Filter Material ---/17--- .............._...... Distance to nearest: Well _0.0 _ ..._.___. Foundation ...._/A........... Property Lim .....IF............... ,�/ i SEEPA6f Fi [t.]/ Depth ._.-�O_....... er �.Y B! Number .........f............... Rock Filled Yes 2t No i❑ , i Water Table Depth .............�.P.�.......__.. .._._.-.._Rock Size Distance to nearest. Well ........fVIP-._..-_-.-........Foundation ........... Prop. Lino r REPAIR/ADDITION(Prev. Sanitation Permit# -_-.....______---.__.___.............. Date .....I t Septic Tank (Specify Requirements) ........................... • ' Disposal Field (Specify Requirements) ...........•........................................ • ....................................... .................................. . .. ....... -----........I._..:. - - -----------.... ......... .................................... ...----------------.----- -------------- ........-- -- _. (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, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ...................... Owner By - ..... .•...................:...._...... .. .. . r-- -- ---- -- -- %R.Q!---- Title . !Rt.FBF .........--------------......_....---'- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .... ........ : ............... -----------------------------.. . . ................... DATE _s�.__ '��..'. .c��..------------ BUILDING PERMIT ISSUED .................------------------------------ .............. --------------- -- ---------DATE _...------ ADDITIONAL COMMENTS ................... ------- ----------•------------•----..:....---....-----.........-..--.--._---------......-------------- --------------------'--..._...•--------------- _...... ------------- ------- - - --------------- - •------------------------------------------------------ - - - -- - -- - - ------ --- ----- . ----------------------- ---- - 7 - Fina( Inspection by: ----- -- - -- - - -- . ..... .. ..........._.---- ---------..--------.......------...Date .- --•--,�..r. ............-.....I...... SAN JOAQUIN LOCAL HEALTH DISTRICT