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nae vFwlue Wei APPLICATION FOR SANITATION PERMIT .:.J......................... ... IComplets In Triplicate) Permit No, ... 26.................................................. ..... su Data ised .'�:.. `... ••••••••••••_•-••-••••••• ••••••••-•-••••••._..•_•••• This Permit Expires 9 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 Regulatlons: r n O : � .........................................CENSUS TRACT ......... .........•• JOB ADDRESS/LOCATION .J. F�Sf OwnS�s Name 1..............................................PhoneD . . 6✓ . �^ A°rddress Ci ............ .........r.............................................. .... /Contractor's Name ...12-11 - 2- .._ ._ � ............................................license#2 i` 4A... Phone Installation will server �esldence�'ApartmeM HoursQ Commercial 011'raller Court D Motel ❑Other ............................................ Number of living units:---------, hiumber of bedrooms ._/ Garbage Grinder ............ Lot Size .................................... .:.... iWater Supply: Public System and name ................................._...................._......._.:......._........................_.....Private J;Er ( i Character of,sotl too depth of 3 feet: SandCl Silt Q Clay ❑ Peat❑ Sandy loam❑ CPay Loam[3 Hardpan E] Adobe ❑ Fill Moterial ---...... If yet,type............... .. (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc must be placed on reverse side.) NEW INSTALLATIONt (No septic tank or seepage pit permitted if public sewer 1 available within 200 feet,) .�.�_ PACKAGE TREATMENT ( ] �` [] SEPTIC TANK Size..A�;7"_- •_-, . Liquid Depth ...........:.............. Capacity -�Rr[!Q . Type ..fad.._..... Material...................... No. Compartments .tx- !..-. } Distance to nearest: Well 1je0._._........._...........Foundation ........... Prop. Line..............._._.! No. of Linos .-.. k LEACHING LINE ( ] o}.-.._.... .-. .. Length of each fine..70 ............... Total Length .'��P_:_:.........� - V Box .1........ Type Filter Material .....Depth Filter Material .Z.-f?...................................o D Distance to nearest: Well ....-................. Foundation ........................ Property Line ....... SEEPAGE PIT ( ] Depth ...1_.............. Diameter Number ............................ Rock Filled Yet [I NO C)t tWater Table Depth ................................................Rock Siza ................................ - ! d iDistance to nearestr Well .......................................Foundation .................... Prop. Line _.................... REPAIR/ADDITION(Prey.Sanitation Permit# ............................................ Date ......................._......... ( Septic Tank (Specify Requirements) ...........................................:.........................._.... ....................... . Disposal Field (Specify Requirements) •.............................._........................_.._........4..............._.. C. ..................................................................................................................................................................................................... . . i`. . ..............................:.........................................................-........................................................................_.... .....Y (Draw existing and required addition on reverseside) LY' 1 hereby certify that 1 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 Ilcen- sed agents signature certifies the following: "1 certify that in the performance of the work for whiih this permit Is issued, 1 shall not employ any person In such manner as to become subject ttto+Workm�aa ' Compensation laws of California." Signed •6d-� f "? "•.:._.......... ................................. Owner v By.. ...... Title __. ..._... ... . ...... ilf other than owned I I FOR DEPARTMENT USE ONLY lAPPLICATION ACCEPTED BY........... . ...r........................................._............................._....... DATE ...... - ../.,9._ ..7��....:...:r: BUILDING PERMIT ISSUED................. . . .............:...........DATE ...........7........,...................... ADDITIONALCOMMENTS .............................................................................................................................................................. _.................................................................... ............................................... . . ........... :..................•. ... -- .. ............. .....: . . ........r .. ... ...... .. .. .. Final Inspection by: ...........:c.-' '.........................:.............................. ...................!K.............Date ...rdr. /� -.T EH 13 24 1-60 Rev. Sal SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7L 3M R�