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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT _ _ /� _..... . . . _ ................_.......... . _J`` Permit No. . 9 (Complete in Triplicate) . .......... ...................................... Date Issued ..li..::....../.�✓ ........................................................... This Po,mii Expinis'I Year From Dateluued Application (s hereby made to the San Joaquin Local Health District for a permit ro construct and install the work heroin —s described.This application is made in compliance with County Ordinance No. 544 and existing Rules and Regulationsi ' JOB ADDRESS/LOCATION �S•O',j7y/.. ...L.l4m'�.w.If?Cc 1.L.f�Sr�....KKO... ......................CENSUS TRACT .......................... Owner's Name ..............1.QfX....1,! .Ga.lr.0. A�C.Y". '......................... ............................. .....Phone 3,6&..cro.e........ Address ....1.J ei..60.....�A_�PLaip...F[t..t ....................... City .... >JCAAEFK!P..Atp.......................................... Contractor's Name ....... ....License # >5 ... Phone Installation will serve. Residence [Apartment House 0 Commercial []Trailer Court O Motel ❑Other ..... ..................................... Number of living units.......... Number of.bedrooms ........Garbage Grinder ............ Lot Size -- • -•• Water Supply. Public System and name ...........:....................................i............................................................PrivateN Character of soil to a depth of 3 feet: Sand j] Silt❑ Clay ❑ :Peat❑ Sandy Learn ❑ Cloy Loam ❑ Hardpan Adobe ff fill Material ..`:�.�.:t...If yes,type ............................ (Plot plan, showing size of lot, location of system In relation to wells,_buildings, etc. Lust be placed on reverse side.) NEW INSTALLATIONt jNo septic tank or seepage pit permitted if pu//ylic sewer Is ovoil blf within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK1 Slze....�f.../.YX..O,x.-h.... � Liquid Depth ..79F ./c-.:.-: 1 2 Capacity .I��Type r'!��.a.t. Material....a�M.^c.`.! No, compartments ... ........ i f �,,,tt Distance to nearest. Well .:.."w7�..^al ......................Foundation ..!ToO.............. Prop. Line .sit................... U7 LEACHAG LINE R, No. of Lines .........3.......... Length of each line......yu............. Total Length ACK..'�............... l7 'D' Box .....3.... Type Filter Material F.a.'h.........Depth Filter Material ../$................................... r Distance to nearest. Well ....�1. .�..'......... Foundation ..J.c'l................ Property Line .4.................... N SEEPAGE PIT [� Depth ..pn...S.�..... Diagtete ...... Number .... .................... Rock Filled Yosr No r � r .. Water Table Depth .....Civ .....:......... .......Rock Size . ...................... �.. Distance to.nearesh Wall .....��.5�.1......................Foundation ./fa........... Prop. Line ....... .............. , /t REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ..................................) ti I i Septic Tank (Specify Requirements) ......._....................._._.........................._......._.........._......................_............._................. l Disposal Field (Specify Requlremonts) ........................................................................................... ......................................... ! i ............. ................... ................. ................................. _........................ .......... ...... ................. ._....................................I....... P .. .. ............................................I....._........................I................._............... ..................................... ......................I............... (Draw existing and required addition on reverse side) I hereby certify that I have Prepared this application and that the work will be dam In accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin local Health District. Home ovmer or Ilceo- sed agents signature cortifies the following: "I certify that in the performance of the work for which this permit Is Issued, I shelf not employ any person in such manner as to become subject to Werk 's Compensation laws of California." y. Signed ......... . . .... Owne By q ............................... . . . ._ ...... ........................_...... Title ...... . ....:...._........._._.._............................... I f other than owner! FOR DEPARTMENT USE ONLY ............................................. DATE .......................................... APPLICATION ACCEPTED BY ......................................... ............. DATE .......... BUILDING PERMIT ISSUED ...... ... ... ........ ............... ......... ................................ ADDITIONAL COMMtiNTS.:�..:�.�Z.Y... .c!�G .. ...f.% ............................................................._..................... _........_..........G.......Z.Y....?�i_.s /... t-�J+'+-- '......... ...._........................................................._..................... ^ `, ................ ...................................................... ................................................................ ...........Dat....... ?.r./2/..j../."... ................ ......... ... . f / Final Ins ection b ,�.. ..:............................................................ SAN JOAQUIN LOCAL HEALTH DISTRICT VJ�� n. VIVOA