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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. .. ..- This Permit Expires 1 Year From Data Issued Date Issued L 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 No. 549 and existing Rules and Regulations: `.JOB ADDRESS/LOCATION _e —' _(E�4c �{ r/ >. r..._ CENSUS TRACT Owner's Name Xt, _ .......... .... . . .. ..... - Phone ....... . . Address q fa .. hi rpGeri City - 04W P _ ------------------------------------ Contractor's .... .. .. ..... ....... ..-- �Contractor's Name 0 4�.: (�(J/�L...... . -___- ........................License # R�71-0.7, Phone fnstollation will serve: Residence Apartment House❑ Commercial ❑Trailer Court ❑ v Motel ❑Other Number of living units: Number of bedrooms ..- ..-...Garbage Grinder *e Lot Size WZo-el4j-;�'t- 6.Water Supply: Public System and name ...._.._...___------ --- --- -- .___----------------- ----------------------- .....private 0 Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan IC Adobe ❑ 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 seepage pit permitted if public sewer is available within 200 feet,) � 1 LPACKAGE TREATMENT [ ] SEPTIC TANK Jf(] Size4ek _ 07. _ __ Liquid Depth yEx.----------------- Capacity IWO' Type�ly�/----- _ MoterialA!5l711.G-.... No. Compartments A-....- Distance to nearest: Well f/f.`��-.__--..---...Foundation .v'J' t. -- Ib -- ....... Prop. Line/-? LEACHING LINE No. of Lines f Length of�each h line/00'j ... _ - .. Total length 1p�i 1 'D' Box IYO Type Filter Material/I&A-Depth Filter Material /Ir ..................... ►. Distance to nearest: Well -111�®..-...-..._.- Foundation f'Q Property Line SEEPAGE PIT Al Depth Diameter ._. Number __ ._.-- Rock Filled Yes JR1 No QT Water Table Depth ------------------_.........Rock Size .�r-,. .._. _ b T Distance to nearest: Well -._.---------------------Foundation d'o_ ...--.- Prop. Line,/..1......... p j 4EPAIR/ADDITION(Prev. Sanitation Permit# ---- -._ _..... .. ._ Date ------------------------ -- _.......I ------ t` Septic Tank (Specify Requirements) _ _ .... .:.___ Disposal Field (Specify Requirements) --_ -------------_-----_-- - - :.... - ..__..- .... .. .. .. -.._. . ......- -. _.... __......-- . - -- (Draw existing and required addition on reverse side) Lhereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin ounty 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 ,.is to become subject to Workman's Compensation laws of California." Signed _.. . _...- Owner :y 1.r8''e.E�jil' _ _ ._ . Title .. (if other t owner) EPARTMENT USE ONLY _ 4PPLICATION ACCEPTED BY . DATE J—I_L3 BUILDING PERMIT ISSUED DATE ADDITIONAL COMMENTS -.. -- - .............. - - l Final Inspection by. . -.-- jp� _- __. __. Date !`? LSAN JOAQUIN LOCAL HEALTH DISTRICT F u 13 241--An V.,, csA , i,o o v