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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT + ......................................................... Permit No. _....l.." D (Complete in Triplicate) t � / p ` Date Issued -C./_�.J.��-.J ti .........................................................I This Permit Expires 1 Year From Date Issued Application is hereby made.to the San Joaquin Local Health District.-for-o-permit-to-eonstruN-and�wstall the work herein ;e described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: r.._ 1 JOB ADDRESS•/LOCATION.._.... ... _.�.- .. ...�. Ilk- :Y....1.,:C�......_<•,,;11_ ..............CENSUS TRACT ..._......_... Ir Owner's Nome ....(.:✓�i�..�..�:__..._....._......_i....____. ..__/ _.,...._.i�__..__t............................................Phone ... ,� .,,{ - y� Address ............... . C/r`i2= 1 =1 _...d.7J .City .-...:.� !'L�. _--------- ---2 b 'Y �. .... ..License# �� __. Phone :'�,E� / ... Contractor's Name .........,.2. 7...c..�.£.._.. ........................................ s.: Installation will serve: Residence❑Apartment House Commercial Trailer Court fl�lL 5 Tti'-/�1L�'Z �._ Motel❑Other........--••-- ...+.. Number of living units:............ Number of bedroons ............Garbage Grinder ............ Lot SIze _____..........................._.. 15.,t Water Supply: Public System and name ......................... .... _ .. P ate. Peat Sand Loam Loam ii �tW r Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ ❑ y ❑ Y D t ; .� xk•.. I; w; Hardpan❑ Adobe Fill Material...yti--If yes,type. _ * , F (Plot plan, showing size of lot, location of system ja_re)atien to wells, buildings, etc. must be placed on reversT aid . .. w NEW INSTALLATION: (No septic tank or seepage nw it-poitted if public sewer is available within 200 feetji * t r PACKAGE TREATMENT [ ] SEPTIC TANK Size...._.I_,-,.5...._._....._...«..._...._ Liquid Depth 4.. .S�i =` . Type.G. r-C .. Material....�:Lfl �i No. Compartments C +� Capacity Distance to ne"crest: Well Foundation...........:._.._.__ Prop. line_....... » ' Fr / + ' i '' • .. LEACHING LINE �Q No. of Lines �..�..�--_.__.....t... Length of each line :............... Total Length .�p�?. �{ , 'D' Box ............ Type Filter Material i ' ..Depth Filter Material �3.... .: :_ J YP t f I• ` �` Distance to nearest: Well L .............. foundation �.........__._._.. Property Line ,� :.. �.- :•'.. .. Number �.?...)............... Rock Filled Yes j8 No ID ,.• SEEPAGE PIT [ ) Depth ...1.. `�. Diameter �� t 'Wate7 Table'Depth r:: Rock Size................................ �._..._ i •= -�'t Distance to nearest: Wel Foundation .................... Prop. Line ........... .� �. REPAIR/ADDITION(Prev. Sanitation Permit#............................................ Date .................................. 1 { •r,°i :� Septic Tank (Specify Requirements) ...................__..._._.._.........._...................... ........._...._«........-_.........._............._................ _ Disposal Field (Specify Requirements! ....... ............... J _..................... � r� Al + /// '' L fes/ _l-�V %L� .4.v..1._.0...................... h/ •... .:...............•___•__•__.........._........-•-_......... .. ••___.._._..__•__...«..._. .:: •• .................................. .. ..._...... « ♦. u} (brow existing.and required addition on reverse side) I hereby certify that I have prepared this application and that the work will ba done in accordance with San Joaquin .. • ... County Ordinances, State Laws, and Rules end Regulations of the San Joaquin Local Health District. Home owner or (lctn- :; x- - sed agents signature certifies the following: .ti fhat.iS the performance of the work for which this permit is issued, I shall not employ any person in such manner as f!become biect to orkman's Com nsation laws of California." zcaner BY j j f1��-�C �L'r'• ! ,.:.4:L..:L ....... Title ..-- .r.^ ._. ..u«............................................. 1 ..... If other than owner) ✓ M FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED rsY BIJILDIN6-PERMIT-155UEC�-:.—....-..:.:.:.-.-...:.:.:-::: ..-... .: DATE...- . - .:- ...�( .6_Q......_..._ ........ ..................-...................... .,.:;-. ...,} ADDITIONAL COMMENTS ........................................_._.....................-........._....-............_..._........._..._._._................. ,.:.: r:t !.. .................. ..................................................... ............. ......-_.................... .. Date..- !. .. _.,15�_�..c ..................................... 6;7 .1.b. ..._.._. Final inspection by; .................................... «.. SAN JOAQUIN IOCAL HEALTH DISTRICT .'z E.H. 9 1-'bB Rev, 5M