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FOR OFFICE USE: --- �•�,k _ APPLICATION FOR SANITATION PERMIT `; :..�_.....'...._._.. •-• . . .................. - .. (Completein Triplicate) Permit No. . . _G.... i - - , i This Permit Expires 1 Year From Date Issued Date issued ....................................... :,.....__.._... . Application is hereby made to the San Joaquin Local Health District for a permit to construct and Install lib cvork herafa- described. This application is made in complian with County Ordinance No. 549 and existing Rules and Regulofi'Sns. } JOB ADD..R..E..SS..J....Q......C..A.....O......., .. `t�'1. _..r � _._,.P...E_.'.C.......,..tQ...... i,x.!..e._......_. ....................C....N._PShUoSnTRACT R. /CT Owner's Name Address .: _. . ............._......_......City �.?!7;F TR.0 Contractor's Name .._ _ , {�.�Qjls ._. Q�( '__...rZN•c - --•- - r-....License# ........................ Phone . _¢�.� Q� Installation will serve: Residence Apartment House❑ Commercial❑Traller Court ❑ Motel❑Other...--n.......---------• ._...._..:. Number of living units:.... Number of bedrooms ..�F„1. .Gcrbage Grinder . Iw Size - - ...... ... .... .................. Water Supply: Public System and name ...............................�_......---...._...Pa Character of soil to a depth of 3 feet: Sand❑. Silt❑ Clay ❑ Peat❑ Sandy Loom [j Ctay L*am4 t Hardpan❑ AdobegC Fill Material ............If yes,type {Piot plan, showing size of lot, location of system in relation to well:,.buildings, etc. must be placed on reverse side.1 NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 240 feet,) PACKAGE TREATMENT { ] SEPTIC TANK Size.._._•--.-----•-.. .................... Liquid Depth ............. _. Capacity --_---------------- Type •.......... material...................... No. Compartments ...........,...w...� Distance.to nearest: Well ................---......__ ..__Foundation .......•-•---...... prop Line --- •......._....: . A LEACHING LINE { j No. of Lines ........................ Length of each line............................ Total Length 'D' Box ....... Type Ater Material ....... . ......Depth Filer Material ......... ........._....................� Distance to nearest: Well ---------.•-_-------. - Foundation SEEPAGE PIT j ........................ Property Line ............ ........_. P - Diameter: -------•-------- Number .......,.�.................. Rock filled Yes ❑ No Water Table Depthr - Rock Size .-.------------------------ ._............................. r Distance to nearest: Well ------------ foundation Pro Ltne REPAIR/ADDITION(Prev. Sanitation Permit#.................. I.._.............---____. Date ..--.----_:... ...._ 1 � t Septic Tank {Specify Requirements) _..:. •....---)5.1.;3.�'_.t.��--.. � ' Disposal Feld 5 eci R -► I { p fY Requirements) l f3sa 1 .. . e ...°t.d.....B. .._.... --•--------..... ............. ....... 40/d1l.. E ..... t, � `_. ......n. . .. • L • .................................................... . {Draw existing and required addition on reverse side) I hereby certify that i have prepared this application and that the work w111 be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of ihe,$on Joaquin Locos Health,District.Hoene owner or liew sed agents signature certifies the following: _ "I certify that in the performance of the work'f6r'which Ibis penn'tt is Issued, t!dial, not employ any person in such mannor as to become subject to Workman's Compensation laws of California:," Signed ..._�t_ .i1�:19t£t '}f_..1f--�1a ...... tit---- .------ {if-Other_tl owner) ................... FOR DEPARTMENT USE`'ONLY APPLICATION ACCEPTED BY ._._ ... DATE .., +��7 BUILDING PERMIT tSSUED _...:_. ._.__..__. _--- -- -._...,:................... ................... --•-- •.-•--- ---- - ..............DATE -..�- AUDITIC►NAL COAAMENTS' -._._._._._ _....._- _ ---•.................. .. . _._.._,._�.- .................... . ........ --•---...--•----_ .......I—...... ........... .... ...._. __ final Inspection by. .._�.��'�'•�-r✓�----•--.• __ � - - - -- .... . -•- ---................-•- •--- „� EH 13 2L 1-63 V. 5�i � ... . ... ...... . .--��.. .......Dat -�`_.,�......6`s. ...... :.. SAN JOAQUIN LOCAL ALTH DISTRICT $/741 3M