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r- FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----------- Permit / (Complete in Triplicate) -- ---- - --- -- -- �/-------------- ti� , �� .---_— """" � . Date Issued 3:-Z3:•-j Z _ _- - ---_-•------- This Permit Expires I 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 No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ._ (LZGY�__ r...[/1 �'W------- - 7f..--......-•••.-----------------------CENSUS TRACT -----------------_------ Owner's Name --- --- • -- --- ---•-------•....__------- Phone .............................•..... ----- ----- Ate Address 1-- -.� W------. City ------... w c ---- f 1 ' , Contractor's NamePE d --------------.License # 1. ._ I_�-- Phone �J�Q . Installation will serve: Residence KApartment House[] Commercial ❑Trailer 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 a depth of 3 feet: Sa d.r a k-Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam ❑ Hardpah:❑ Adobe'❑ Fill Material _.. _. ... If yes, type ----------- ------------- (Plot plan, showing size of lot; Iodation of system.in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic lank or seepage•pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK.1 ] Size------------------------------------------------ Liquid Depth .......................... CaP tacit .._ Material______________________ No. Compartments ...................... y ----------------: Type ----------------- P DistA' e1tds.nearest: Well ------ -------___--------------Foundation ........:------------- Prop. Line ...................... LEACHING LINE [ ] No. of Lines'.----- Length of each line____________________.--.-_ Total Length ..........................•. 'D' Box .. Type Filter Material --------------------Depth Filter Material .............................................. Distance to nearest: Well ------------------------ Foundation . _..__-.-.__-._ ....... Property Line_ ........................ SEEPAGE PIT [ ] Depth ... Diameter ................. Number . _ ___...... Rock Filled Yes ❑ -No ❑ Water Tablo'.Depth ---------... ..................................Rock Size --------- -•-------------- Q Distance to nearest: Well ......_:...__ ...................Foundation .......-------...... Prop. Line ---_-_-__•--_-__-_---- REPAIR/ADDITION(Prev. Sanitation Permit# --------------------------------------�.-Date ._�_..-..---..._._...__.._.__.._) • \ Septic Tank (Specify Requirements) -----------------. ..........I -- t Disposal Field (Specify Requirements) --••• �. ••........ --- - t.l'C I - 4 ._..._..._-___.._---------------------------------_--------•-_-----•----'----------------- . "(Dravf existing and required add ition'`Pn.reN erse side) 1 hereby certify that I have prepared thistapplitation 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 ----•---•--- - Title e - r-ter (If other th wrier) FOR DEPARTMENT USE ONLY It APPLICATION ACCEPTED BY .. ............ -------------- -----------__-------- - - ------------ ---------- DATE --- BUILDING PERMIT ISSUED . --_1. = r;-- --- --•-•- ----. .--:......................... .............. . ADDITIONAL COMMENTS _ 1X _�.T__? .._. •z-- _____ ..w..w_ ' fvc.Gl mac. - Y'�• c�- .r�! . _ OF ................ ................................... ------------- -------------------- ------------•--•-------------•----- ----------• ............................... -•-••---• -------- _1 -•...•-----•---•................. ------` ` Final Inspection by: l ^"._......'• - =` "' = _" :��" _ :.__ .Date --- rr -- -. �._...._ - -• . �%� SAN-,JOAQU_I,N-. LOCAL HEALlNDySTRICj 3�i r