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FOR OFFICE USE: 1� APPLICATION FOR SANITATION PE IT __ _.._..__. -... (Complete in Triplicate) PermiYNo. ?) --Z"- _ This Permit Expires 1 Year From 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 madg in compliance with County Ordina;p5p N 9 and existing Rules and Regulations: 1Po R'Hre e F i Gi X31 S— � : c y 7 JOB ADDRESS/LOCATION -I'rfL�ia�--/�Sd��R- ---�Jy>---�s C `+p' - --�k - --CENSUS TRACT -_"-._-_.._... ----_ Owner's Name ..�'G�sI4L- ---1c-ttYtct!._G ----------------------- ? _ ) 2 - -- - -- Phone -.!�_Cr-�S�-yam Address -."44 9/ RC--- --- ----- -- -------- city ---/1.L h'' rn 1�0 --- • ---------------------- .r ,X4C,�'Sp�L . Contractor's Name. - .�41C. i 1y.. ,.Qi�r� YPTi.s.y�. _tYC.____License #1,017_ '� - --- Phone .4-Y.j.9-19.71... Installation will serve: Residence NJ Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other - -------------- - ................ ------ Number of living units: Number of bedrooms __r3----Garbage Grinder -- --------- Lot Size _ - .X. ,-p.-f':4_...-._. Water Supply: Public System and name - -- ------------------------- ------------------------------------Private$ Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam ]9 Clay Loam ❑ Hardpan ❑ 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,) N PACKAGE TREATMENT [ ] SEPTIC TANK ze----__RaA�.tili.,..__10o .G. Liquid Depth 111 (� Capacity ��Q_n. -. . Type 66Lx 61AT Material Pile8-eA. r No. Compartments ------ I._._...__- 1 U Distance to nearest: Well _...fE3______-------------Foundation __ ___ ----- Prop. Line---910)-_._.-.. . 1 LEACHING LINE No. of Lines ^ °�.__._ ___. Length of each line__./`©Lt_.---_..-_ Total Length .._�-4'.-�-_._----. 'D' Box __2-_.. Type Filter Material -W&P-6-4-0,tepth Filter Material -.--------Cir._"_------ .................. `V Distance to nearest: Well _7S--_---- --- Foundation _3.L$) Property Line ---------- SEEPAGE PIT �jJ Depth _ S-�...._-- Diameter -_. �_`..�NNuum`ber _ -------------- . Rock Filled Yes No ❑ Water Table Depth ___........... .-:-_-I�t_#_c1L.-Rock Size Distance to nearest:,Wgll ../ G�'__.___ ------------- Foundation _��. --- ----- Prop. Line -------------- REPAIR/ADDITION L! ,-..--.-.REPAIR/ADDITION(Prev. Sanitation Permit# __... Date ----------'___---_--------------I Septic Tank (Specify Requirements) — — - - ------ __- - -- ------- -------`----------------- - - ------- ----- ---------- ------- Disposal Field (Specify Requirementsl ......_------------------------------------------------------------------ ----------------------------------__--------------- -------------------__------------------------------------_..--------------------- -------------- --------.....----- -------------. .. - - ------ -----------_._------------------- (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 bo subject t Workman's Compensation laws of California." ec k Signed < r �i..-s-«r% ,--'------ . ------- Owner By - -- -- -- - Title . .- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY f✓ °= r ph - .... .. - DATE BUILDING PERMIT ISSUED - - ...... - - - - - - .......DATE ------- --------------_ ADDITIONAL COMMENTS -- ---- --- ------------------- -- ----- --------- _ ...... - ----- -- - — ....--.-- --- ---------- ------- -- -- ---------------- ---- ----- -- ----------- ---- -------------- .. ....... ........ -- - - .. .. - - _ Final Inspection by: --- 1 --- ---- ---- - ----.._ ---...-- --Date - ---- ---- - ---- SAN JOAQUIN LOCAL HEALTH DISTRICT r 14 0 1.'AA Dm, KAA