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r FOR'OFFICE USE:,� APPLICATION FOR SANITATION PERMIT a -70 // r (Complete in Triplicate) Permit No, -- -- - ----- ---------------- )d Date Issued _________________________________________________ This Permit Expires 1 Year From Rate Issued Application is hereby made-to-the San Joaquin Local Health District rfor rd pp y qpermit` to construct and install the work herein described. This application is made in compliance with County Ordinance No. 540`and existing Rules and Regulations: I JOB ADDRESS/LOCATION . D - Gf� le-1---- ------------------- - ----CENSUS TRACT -------------------------- Owner's Name ------1-*A6c,,r---- ------------------------------------------- - _ ...__-.__Phone .__.___ _._ - Address ---- ------------------------- City ------------ Contractor's Name ------ f_T _-- _p-Q/ `---.t�.-r--_------.License # � _�.�Phone 11Z- __:44f� Installation will serve: Residence Apartmen'fHou e E] 'Com merd alp:❑Trailer C60rt, ^❑ FMotel F1 t'he ✓g _ _ _ _ > ` i Number of living units:_._i t__ Number of bedrooms..- _aGarba e=Grinder Lot Sze ... _ ___.__. r :.. / 14 Water Supply: Public System :and name _ /�- _ :�______ /_ r _ e- - ___ i 3� F - _,eyo' �Fe 0---------------------4 Private ❑ 'Character of soil to a depth of 3 feet: Sand'❑ Si t❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Lodm,0 Hardpan ❑ Adobe Fill Material ------ ---- If yes, type --------------------t--_-- I. I pq (Plot plan, showing size of 'lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) T-di - w NEW INSTALLATION: {No septic tank or seepage pit permitted if public sew r is varfableAwithiri 20�#eet,} ' PACKAGE TREATMENT f ]SEPTIC TANK f ] Size------------------------- ---------------------- Liquid Depth' _--------------------.----- t ! . Capacity -------------------- Type ------------------- Material------- ----- _ ----- No. Compartments n)e to nearest: Well -------------------------- Fo ndation ---------------------- Prop. Line,--------------- ------ 't ` Dista ___.____Fou LEACHING LINE (] No. of Lines g g Len th of each Eine Total Length � -`-s-Q- ...- F D' Box _.611_ Type Filter Material / -l' Filter Material ��_______�..:...:...............:.. ' it Distance to nearest: Wel! __________ Foundation ----------- Property Line -------------------- SEEPAGE _-___SEEPAGE PIT [ ] Depth --------------------- Diameter Number ---------------------------- Rock Filled Yes ❑ No .i❑ Water Table Depth ----------------------------------------- ------Rock Size ------------------------------ - i4 Distance to nearest: Well --------1------------------------------Foundation -------------------- Prop. Line ______________________ REPAIR/ADDITION{Prev. Sanitation Permit# ---------------1--------------------------- Date ---------------------_--------_---) Septic Tank (Specify Requirements) posal Field (Specify Requirements) -- -__- ---_ _ ------_ __,Dis _: _ _ ----_-- --- rd u J ------ -----------P -r'- - I g ------------ - ---------------------------------------------------- --------a1------------------------- + I hereby cerci that I have prepared this application addition on reverse side) (Draw existin and yfy p p pp and that rhe,work will be done in accords ce with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin litocal Health District. Home owner or licen- sed agents signature certifies the following: I "I certify thai in the performance of the work for which this permit is issued, I shall not employ any person. in such manner E as-to become subject,to-..Work man's4Compen_sation4ow of California.", Signed ------------------- -- -------- -- ---------- ---- - -- --------------------------------- Owner By -------- -- ----- If tan owner Titlf - ---- FOR .DEP RTMENT IJSE`ONLY -- -- APPLICATION ACCEPTED BY ----- DATE -- `�74 - BUILDING PERMIT ISSUED ---------------- ---------------------------------------------------- ------------------------------ DATE ------------------------------------------- �. ADDITIONAL COMMENTS --- --------- -1f-- --------------------------------------------------- --I----------- ----------------------------------------- -- --- ---------------- ------------------ ° ------------------------------- L Final Inspection _,<7__1 J-3 t' j Date �'� N JOAQUIN LOCAL HEALTH DISTI1ICT E:-H:•9—�, 69µR,v=.-5M