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FOR OFFICE USI::- l ,APPLICATION FOR SANITATION PERMIT 71 /13� No. ------------------ ----- J - .. i Permit r (Complete in Triplicate) _.._ Date Issued ____ _ Permitres - 4-111 This Expires 1 Year From bate issued � ' , 1 Application is. hereby made to the San Joaquin Local Health District fora permit to construct and install the'work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and I§egulations: JOB ADDRESS/LOCATION _// Aft , 5�Ti'e�P 0V_6- ' -' CENSUS TRACT ...... ---------- ---------- Ir- f_..__ Owner's Name ��f ,�---��-��-�(►i�.>�y°i[------------------------------------------------- `----- ------ Phone'; Address-/J.:a 4Q_V_ - 1 , ifJ°- L?- 1 City -y •� �rr�i = ;--------------- License ci" Contractor's Name Jl---------------------------------------------- - #4 Phone Installation will serve.. Residence [] Apartment House❑ Commercial :❑Traile6Court ;❑ I Motel ❑ Other _-- pi4?1V0_- Number of living units:.-/----- Number of bedrooms�------- Garbage Grinder-�`_____.i Lat Size. __- ___�7- t T7 Water Supply: Public System and name---------------------------------------------------------------------------- ---- Priy to I Character of sail to a depth of 3 feet: Sand'[]Silt ❑ Clay El Peat El Sandy Loarri [1 Clay Loam Q Hardpan F]Adobe '❑ Fill Material _____------ If yes, type ---------------------------[ (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 seep 'e pit permitted if public sevyer is available within 200 feet); 1, 4f PACKAGE TREATMENT [ ] SEPTIC TANK'[ Size _fit_-"---- .- Liquid Depth _ ---.------•.--?---- ',; 1 Capacity Material �No.` Com artments' i---• ,y - p tY �+�- -- YP ��` --r . _ T e - - - p Distance to nearest: Well �Q----------------------Foundation %„'�,-_-- - Prop. Line ;2110----_-_-_-i---- or� 'r LEACHING LINE [h/No, of Lines _________________ Length of each line- _ [�----- __j Total Length __ __ -_ ____ U�___ 'D' Box ��--- Type Filter Material,-C1�-----Depth Filter :- Distance to nearest: Well ---6- 0-_______--__ Foundation - _f ______I__ Property Line � .----------•4 ••. SEEPAGE PIT [ ] Depth ___________________ Diameter ---------------- Number -------------- -"..... -. Rock Filled Yes ❑ No I G Water Table Depth ----------Rock Size -;---''---- ------------------- Distance to nearest: Well ---------------------------- ------------ Foundation _ ---------- Prop. Line -------- REPAIR/ADDITION (Prev. Sanitation Permit #-------------------------------------------- Date ------------ -=------ 2:---------.---1 fw1 4 p , fi Septic Tank (Specify Requirements) --------------------------------� t -------------------------- -, ----------------------------- ------------------- Disposal ------------------------,-•- ------------------------------------------ - j Disposal Field (Specify Requirements).-----------------------------:-�:,=�---- ----------------------------- ._� � w_::�------------------ ------------ E' .- --------------------------- --------_--- -- ---------------------------------------------------------------- -------------- 1 ----------------------------------------- ---------------- 1, (Draw existing and required addition onj reverse s de) F � I hereby certify that I have prepared this application' and that the work will be -done in accor.dance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San -;Joaquin Local Health District. dome owner or lacn- sed agents signature certifies the following: I•-- ` - - �� . "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 become subject to Workman's Compensation laws of California.” j Signed - -- Owner d. c Title 01--------------- - -- ---------------------- --------------------------------------------- BY------- = (If other than owner] FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY BUILDING PERMIT ISSUED ----------------------------------------- ADDITIONAL COMMENTS __..__---i-_____ "________'-------------- -------------------------------------- Final Inspection by: __-_-. ------------------ - ----------------------- ----------- -------=------------------------ : ---------------------- ----------- -�� DATE ------------- ----------------------- DATE --------- --------------- = ' -�------f ---------------- ----------------------- ---------------- ------------------------------------- -------------------------------- ---------------------- ---------------------------------------------------------------------- ---------------- - )- i [ ----------------------------------------------------------------- Date 1� a'� 4 �"7 -------------- --------------------------------------------- •w .� � Y � � � { � SAN JOAC,2UIN LOCAL. HEALTH ^DISTRICT r u 0 1 _'AA Rav SM