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FOR OFFICE USE ' APPLICATION FOR SANITATION PERMIT '! i...............................I................ Permit No. .... lComplete in Triplicate) .......................... This Permit Expires i Year Fsdm Date Issued 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 wl. County Ordinance No. 549 and existing Rules and.Regulationsi JOB ADDRESSAOCATION�...�....�..7" 1"1 .... .. . .. .� fe...! - .............................CENSUS TRACT ._....................... Owner's Name ... 6lrL.aR s.0 ... �frr.�r�.......................... Phone ................................_.. Address ................... r! ...71 � .. city .. ..... .... ..........................._... Contractor's Nome ..... �.. ..... .. JI ......•....License # .191.3 X.. Phone ...................... ..... Installation will serve. Residenc [►f ApartmentHousefl Cornalercial QTralier Court 0 i Motel C]Other ...._A—A. t?... AAA... Number of living units............. Number of bedrooms ............Garbage Grinder ............ Lot Size ............................................ Water Supply, Public System and name ........................................................_.............._........_....:. .. . . .......Private Q Character of soil to a depth of 3 feet, Sand r3 .Silt❑ Clay ❑ Poor[3 Sandy Loam Cloy Loam❑ Hardpan❑ Adobe ❑ Fill Moteriol ............ 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,) PACKAGE TREATMENT [ ] SEPTIC TANK( ] Size......................... ............... liquid Depth ................. Capacity-------------------- Type .................... Material....------............ No. Compartments ..............._.....00 Distance to nearestr Well ....................................Foundation ...................... Prop. Line ..............._.... LEACHING LINE [ ] No, of Lines ........................ Length of each line............................. Total Length 'D' Box ............ Type Filter Material ............... ....Depth Filter Material .........................I..............I.... � Distance to nearesh Well ........................ Foundation ........................ Property Line...................... :.d.. . SEEPAGE PIT [ I Depth Dkametar ..........._... Number ............................ Rods Filled Yes [].. No Q� Water Table Depth ..........................................._...Rock Size ................................ ... (� Distance to nearest, Well ........................................Foundation .................... Prop. Line ........_............ REPAIR/ADDITION(Prov. Sanitation Permit# ..................._....................... Dafe ......................._......... J SepticTank (Specify Requirements) ................. .............. . ...............�.........................._.................................................. poso1 Fiel (Specify Requirements) - --- .•� n`� •••-wr•••..........._.:....._.. ¢ Di. ... -.../ �7r+.- � �1.. r*..L?l�r. ...:.lel'....................... • 1 .._.... ..... o.�.r ....... . ..._ � .......... . . . ..... . (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 Lowe, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or licen- sed agents signature certifies the failowingi "I certify that In the performance of the work for which this permit Is issued, I shelf net employ any person in such manner as to become subject to W man's Compensation laws of California." Signed ......................... .....i......... �.. . J. .......q...�............ Owner �. By ..... .... ...... ............ ..e'.: r/ /.....j.:K',....P"'►'"4-Z............ Title ------ ................... . hf other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY......... :. ...................... .._ ........... DATE ... .«.-.7 ....... BUILDING PERMIT ISSUED ...... ...... .......................... DATE ADDITIONAL COMMENTS ..riL.F7.`� ` ...2{4............ ... ir e}c��u lw .r........... .,......................... ...............:............................ ....--•-..... ............................ .................. ... ...:.......:................................ ............. ........................................ ............................. .......................................................:................................................................................................... .............. ... ............ Final Inspectionby. ............C�Z.,,........_.......... ............_........._..............................................Date ...�i.: 1�..7�-- ....... SAN JOAQUIN LOCAL HEALTH DISTRICT c u 13 24 . •ie e_.. to