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FOR OFFICE USE: ...............I---------- APPLICATION FOR SANITATION PERMIT ICompleto in Triplicate) Permit No. . •` 3 9 ............:....._. I 1 This Permit Expires t Year From Date Issued ©ate Issued ._/.�.' Application is hereby made to the San Joaquin Local Health District fora :gra described. This application is made�in compliance with County Ordinance No. 5.49 and nexisti g Rulestanthe egul�ons.. ' JOB ADDRESS/LOCA - Owner's Name . -_.... y. CE ` Ola.... ......_.)..... TRACT v ..:...:......... ...Phone . d, Address .._..... 4.zp •-- city _. Contractor's Name ......... . .... ......... ----------- - ....license # rf,r .. ,� Phone Installation will serve: Residence&Apartment'Houi Commercial 6 �, ❑Trailer Court- � Motel[)Other................. Number of .living units:---...---- Number of bedrooms.:�-�/" _t r ....._ Garbage Grinder ...._...... Size ` Water Su .-,.�+ ............... pply: Public System and name ..-..._ ......................... Character _ .Pr va of soil to a depth of 3 feet: Sand E] Silt Q Clay private ❑ Y D P t t 5aidy Logit► fl Clay Loam ❑ Hardpan i •...,,' r�r` P n�] Adobe, Fill Material ...... If yes,type (Plot plan, showing size of lot, location of system in. Y 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,) f PACKAGE TREATMENT [ } SEPTIC TANK } Size....:................ ......•. . Liquid Depth t .... .. 'Capacity Type Material............ No. Com partments ....;...� Distance to nearest: Well Foundation .. ....... LEACHING LINE j r Line ..................:... No. of Lines � ..... Pop. L 'Length of.eitch fine. *D' Total Length'D' Bax ..:---___.:_ Type Filter Material Depth Filter Material ........ Distance to nearest: Well a•'#Fbun'dation l P .......... ......... roperty SEEPAGE PIT I j"'" Line .................[ ) Depth ~ ..--..... Diameter ---------------- Number __...._............_..- Rack Filled Yes 0 No Water Table Depth -------------------• - ---_- Rock Size ...----.:....----. ... . -•-------•--- - Distance4 to nearest: Well, ?-= . .-- l=oundation�� --.... p. t :.. -•-••-. Prop. Lina ttEPAIR/ADDITION(Prev. Sanitation Permit . .._._,... .. # _......_..._.____.�.............. ...... Date ) Septic Tank (Specify Requirements): ............. .., ,_ Disposal Field S eco ( p €Y Requirements] -- ' / ... I ---------•-----•-•---- ---•--•----•----- --------- _. -•---•--•-----•--•............... ••------ (Draw existing and required addition on reverse side. I hereby certify that 1 have prepared this application and that the work will Wdone)ln accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local 1Health:Diatriet. Hame owner pen. sed agents signature certifies the following: "I certify that in the performance of the work for which this permit Is Issued, ! shall not employ any person in such manna as to become subject to Workman's Compensation laws of California." Signed .._..---•----••-------- - •- - Owner B -- -- (If other n owner Title f R DEPART. E USE ONLY APPLICATION ACCEPTED BY__._-------- ---- --- BUILDING PERMIT ISSUED -- :. -------- --• .------ ---•-- -- DATE .`.� .Z:... ADDITIONAL COMMENTS _._._ DATE ...._._... ------------------ --- ------ ---- -- • •----•----•- ......--..•- k j --'-'-+_i---------•_._._........................ Final Inspection by: -- ........... EH 13 2!# 1--6.13 5K - - - _... _ _ .._.....__..Date ...CS,-.1 - �� .. -�--._ - - .........................."- SAN JOAQUIN CAL HEALTH DISTRICT 8/7h 3M