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FOR OFFICE USE: PLICATION FOR SANITATION PERAT _..... Permit No. ..7:�-�` -•--- (Complete in Triplicate) Date Issued .s...� 'T Datelssued 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 �omplignce with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS ..... - <fS�7l`5 tl � y L _............ .....CENSUS TRACT ................. Owner's Name ......(4..0..h.fq ...... - - • ......... •--....------..........Phone Address ci v..c�.,..... _. Contractor's Name �.A.G.. o.<.�5---�. e.�4..r 1- .....--T .-V. . . ........License # .oR.(.'-/"- 5..1.... Phone Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Troller Court 0 Motel ❑Other ._. ......... Number of living units:.... ...... Number of bedrooms .....cam..-Garbage Grinder ............ Lot Size ......... Water Supply: Public System and name .................................................................................--....... .................Private Character of soil to a depth of 3 feet: Sand E] Silt[I Clay C] Peat❑ Sandy Loom Q Clay Loam [I Hordpdn (4 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,) 11 PACKAGE TREATMENT ( ) , SEPTIC TANK fl' Size..-.- .... e?..../.r/fa.. Liquid Depth _-)4f.._............ Capacity 1`,l U. l Type C1.7/........... Moterial..0&.AP..f.Qt.CNo. Compartments .....� ........... N Distance to nearest: Well .....V1..e�./... ...........Foundation ..-./...U.. Prop. Line ..... LEACHING LINE IA No. of lines �a...._.... Total Len .... .. .. ! %A _......_. Length of each line.---.... ... Length /..C��......_.. 'D' Box .....1..... Type Filter Material .....rrl--. ....Depth Filter Material ........1...(/.-.-1.1.......... ......... G Distance to nearest: Well ...... `. Foundation _..-&0 ...... Property Line .-.�.1111..�.... � r SEEPAGE PIT Depth ....-�'�-�.---.... biometer !ff......... Number ............. Rods Filled Yes No Q 0 WaterJable. Depth. ................9.e...................-...Rock Size .......2--- ..... G Distance to nearest: Well .....Z��----.................Foundation .ICJ.G�.. Prop. Line . V REPAIR/ADDITION(Prey. Sanitation Permit# ............................................ Date .......................-......... ) Septic Tank (Specify Requirements) ...... ....... .OD &1 -....-..- ............ ......... Disposal Field (Specify Requirements) l..CLl1. / 8`... ..-..sko5 -------- •.r -�-�- A (Draw existing and required addition on reverse side) 1 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 become subject to Workman's Compensation laws of California." Signed --- -------------- ---------------- .....- - ---. .. Owner By - ............ ..................... Title ....�1 t w . _............... ... - (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEDBY .. ... . .. .. ..... _.. . . ... ............. - ----------- .............. DATE ..eS�-/.o..:Z ............... BUILDING PERMIT ISSUED ................................--•- --- ...................---............-- -- -----..........DATE ...---------............................... ADDITIONALCOMMENTS ...... .................................. ......................... ......... • ...................... ---------.............................--------•- -_...................... . ...-------------------.............----.......... ---••-........................ ........................•. -............................... ......----............ _........._............... - - - - -- - - - - - - ate �.fr: .. ... Final Inspection by: ........... .. ..... 3'",?2:+:==f4 ---- ... _..._.._.. - ---........------------........Date ..............- -- SAN JOAQUIN LOCAL HEALTH DISTRICT