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c .i FOR OFFICE USE: ::< = APPLICATION FOR SANITATION PERMIT q .. Permit No. .... .1.."'SD c. (Complete in Triplicate) - T• .................a...................................... (e Date Issued ...._4�..�?1 ......................................................... This Permit Expires 1 Year From Date Issued ; J 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 Regulations: JOB ADDRESS/LOCATION . ..............CENSUS TRACT .......................... r --� ti ? Owner's Name . .C!fl�. ...: ......... l.'. .::./ �...� tl.i.- 7 t . Phone �lC.-G4...J��,... . r }; Address .. ... .. .....:-+.. _"�,.__... '/l..l"_..�' _ •✓ J ... tom:.City ......•__ i.:.L /c.✓ i ..... .._.... ._..�� ` ........................ ....License#••�.'.7�1:�.��:�-_. Phoneme Contractor'shame------....:..�.f?...lti.:�. .. ? Installation will serve: Residence❑Apartment House❑ Commercial trailer Court fl yl+LZS 7'/1'r-&Z- ' iS Motel❑Other............................................ Sr`. Number of living units:.......... Number of bedrooms ......Garbage Grinder ............ Lot Size ............................................ Water Supply: Public System and name ..................................................... .•-_--_.-._..y_._�..Q...�.._.�riate Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sand Loam CAy Lo Hardpan F] Adobe Fill Material ....y`�.•-If yes,type.r ��-':�•.- :�{z�' ' (Plot plan, showing size of lot, location of system in.celation to wells, buildings, etc. must be placed on reverse•side. NEW INSTALLATION: Wo septic tank or seepage pit-pe►mitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK �I Size.........h..`�.-_,:........................ Liquid Depth _'_.�_.......!........ /I, 1 _ Capacity ."�� . ^rl:.- Type fGu��(. .) .• Material...11 ((.,R Z No. Compartments �. .......... Distance to nearest: Well .....................Foundation ..................... Prop. Line.............. LEACHING LINE �� No. of Lines �..1_�..........E--- Length of each line..- ........ Total Length . 7�<......._........ ' ... Box ............'D' BType Filter Material 1.: �V k.. e ..Depth Filter Material � ....................... t . �.' rr , j.._... Distance to nearest: Well 1. .............. Foundation s__......_...... Property Line 1--r.... •-••••- SEEPAGE PIT [ J Depth Diameter Rock Filled Yes Wates Table'De; ........................Rock Size ................................. t S ; . Distance to nearest: Wel'..............•........_........__....._Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit#............. Date ..............._---___----.__-__-_) '. Septic Tank (Specify Requirements) . Disposal Field (Specify Requirements) .._ _�J' :2 _--.....--.................. . ......._._.........__..-..._....._.._......._._ � '�L .r �.�.1 ...................... l (D aw existing and required addition on reverse side) , I 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 rf the San Joaquin Local Health District. Home owner or Ilcen- sed dgents signature certifies the following: "1 ca�tify that,i4� the performance of the work for which this permit is issued, I shall not employ any person in such mannas as t become biect to orkman's Com nsation laws of California." �� ' Sign � � ' `•<-tcu�•�..-`�-�+� `�---..'..�G`=--c ----- -----•-. caner By a �` � �. ,(•� i {� ' Tit!e .. ..✓. .�::. ..... ............................. i V.y - -flf other than owner) r i FOR DEPARTMENT USE ONLY ,` ' y "q APPLICATION ACCEPTED rsY........ ....N• :. ! ................... ..........................._. DATE.._.��f ..�.Q.._..... '......_ ; ................:......._......_:......:............: :.:: -,...DATE DATE ..... ..........................i....... a rADDITIONAL COMMENTS..................................................................-_..................................................-..__........__...__._.............._.. ............................... .......:............ ......_................................................_............................... ...... ..........................•-•----..................*...._..._... Finalinspection by: ......................................1 _.U�?-s..O IQ.........._...................._...............Date... !.}�.�-b. .................... SAN JOAQUIN LOCAL HEALTH DISTRICT ti} E.H. 9 1-'66 Rev. 5.M