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( FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ....... . ...... ............... ..�. (Complete in Triplicate) Permit No. ....7.. r.l II QYaf ............................................ .... This Permit Expires 1 Year From Date Issued pate 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 compliance with County Ordinance No, 544 and existing Rules and Regulations: JOB ADDRESS/LOCATION ............. ................. �14�... .!v.........� ..............CENSUS TRACT .::....:.:.....:::.:::.:.. Owner's Name .........CQ cJ. ... - ............Phone.................................... Address .............. J. rr��.... ..... I� .N............. ........ City ......TBA.5.X Contractor's Name .... :c!::...T. .P�..,d.....:...�.................... ..•License ----- .. Phone Installation will serve, Reside ce�a tm nt 1-louse pY mer'c al-OTr rir"C urt a) Motel ❑Other ................................ _.... . l !4 �-6� Number of living units.... Number of bedrooms 3 Garbage Grinder ��' Lot Size .. .. .�� ........... Water Supply: Public System kind name Private �_ { Character of soil to a depth of 3 feet: `Sand Silt Clay Peat Sandy Loomno Clay Loam 0 �� Hard' ❑ Adobe�Fill Ma�.erial — If yes,._"'type "i - - (Plot pian, showing size of lot, location a6ystem In relation to wells%uildings, etc. must be placed on reverse side.) i ar t. NEW INSTALLATIONt (No septic tank or seep girpit permitted If public sewer is ovaiiable within 200 feet,l �r , z , PACKAGE= TREATMENT ( ] it SEPTIC TANK �` Size...-.'---`_ X A a Y 1 Liquid Depth _._._. S �..... .......x.• Capacity ..I.�.............. Ty0\PPB. 5 Material. �� C No. Compartments .�-`�" ...... Qistance to nearest: Well l�Q �Foundation .. �� ... Prop. lines �� LEACHING LINE ( No. of lines .... Length of each line.. . `. '..Total Length ....��—��..f............ 'D' Box Type Filter Material .. . .Depth Filter Material ......4?.............I..• ........... y � 4 Distonce tneoresh Well �f� " :.16 u. `.,.:........:`:� ..... Property Line . ..................• SEEPAGE PIT ( y Depth Diameter Numbbr ............................ Rock Filled Yes Q No ❑ Water Table Depth .............................................Rock Size ................................ Distance to nearest, Wel ..................................... Foundation .................... Prop. Line ...................... REPAIR ADDITION Prev. Sanitation Permit .:... .. Septic Tank (Specify Requirements) ........... ...........................�. ........................................._...I......... ................. 1 Disposal Field (Specify Requirements) . 3 ................. .........................:'J.�r . .. ................. .......r r ... .............................. .. .................k......................-_.....I........................ ................. �. .. _ - .... .................................................... (Draw existing and fequir4d'addlt1W6n-4gvhrse aide) I hereby cerci �tha� t I have II this a licati'on and thatthia'�workt wiilib`i► done �,In'accorclahce with San Joaquin fY prepared Pp Cou�ty'Ordinances, Stats laws, and Rules and Regulations of the San Joaquin Local Hetilth District. Home owner or Pan- sed agen(signature certifies the following:, t a ;_�, "I certify that In the pe rmance of the work for whlch this permit is Issued, 'i shall not employ any person in such rnanner as to become ect t ork s Compenso on laws`of California. Signed.......... ......... ..... q ............................... Owner By .... .. II ... f.L..t. i.`.t�. .Title ......................................... ......... (I# other than owner) I! FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYI..... ...f.O.R..t........:........... ............. ............................................., DATE ....A0.:~A/f*-. .............. BUILDING PERMIT ISSUED .. ' ................................... .,..............................................................DATE . ............... , ADDITIONAL COMMENTS "' ......'.. .................. ..........._............�... 1 .r.�..:s�.. ............................... ............._..................................................................... ....................:............... . //.........-..... .;,: ;.... .;AIM1... ...........................................................6............. ..... .,f.