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r FOR FICE - APPLICATION FOR SANITATION PERMIT �� ...... .... ..... _. .._._._.. . .. _...� �. Permit_ No. � (Complete in Triplicate) ...............................•-------..._.. -71 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 the work herein described. This application is made-in com Ifance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ..- CENSUS TRACT ACT .....................----• Owner's Name ---...Al0...A Y,:9 ............................................ ..Phone . ....-0. 46ZPr ........ Address ..__.............. . . ...-...e.. G-S•----•: . ..... City �� Ta Iq , i ....License # - .. . .Contractor's Nam _ .. . ' . . ... Phone .. . .. . . .. 7.... Installation will serve: Residence IKApartment House] Commercial❑Troller Court 0 Motel ❑Other ............................................ Q Number of living unitss....I...... Number of bedrooms ..�_.Garbage Gri der Lot Size ��. _� ©. f........., Water Supply: Public System and name .......................................•. ._ .. . ..............Private ❑ 1 Character of soil to a depth of 3 feet: Sand El Slit C3 Clay ❑ P ❑ Sandy Loam ❑ Clay Loam K Hardpan ❑ Adobe)o Fill Material ............ If yes, type...................I....... .. (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet, PACKAGE TREATMENT [ } SEPTIC TANK{ J Size......................... ................... Liquid Depth Capacity :.................. Material...... .� - Type .................... _..... No. Compartments .-----••--••-----•--.. Distance to nearest: Well ..Foundation ...................... Prop. Line LEACHING LINE [ ) No. of lines ........................ Length of each line................................................. Total Length N 'D' Box ............ Type Filter Material ..... ..............Depth Filter Material ____........_.................. ........... .. Distance to nearest: Well ........................ Foundation .___......._............ Property line ....................... SEEP [ Depth Diameter ................ Number ............................ Rock Filed Yea ❑ No c Water Table Depth ................................................Rock Size ................................ N Distance to nearest: Well ........................................Foundation .................... Prop. Line ....................ro REPAIR/ADDITION(Prev. Sanitation Permit c# .......;i........4.....:................... Date .................................. ��+ Septic Tank (Specify Requirements) ...._..-F:--Ata I.6.a....................................................................... .._......._..... Disposal Field (specifyuirements) ,2 '_. M .1.? '? .1 ._ __•-cam!= �./y(/_2 12..---•-,•------- .._._.._._ ... tr ------•-----• . ........ S. ..� ._ --.._................................................................ ................----•..... (Dro existing and required addition on reverse side) 1 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 of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following- "I certify that in the performance of the work for which this permit Is issued, I shall not employ any person In such manner as to bgwme UN Workman's Co ensation laws of California." Signed __. - s.. ! R:�SJ -,� �/1 si1�� By _..................................................... title ._.f-4�. ......... ............ ........................ (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ...... -.... .� _.... . .......... ............ DATE .._ ... .� ..-_ .... . BUILDING PERMIT ISSUED ......................................... --- ._ ........_DATE .................................... ADDITIONAL COMMENTS ................................................. ............. ........... .................. _ ina Inspection by: ......I................ ....................... ....Date c 1. s ................ SAN JOAQUIN LOCAL H / H DISTRICT