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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �/ �. ........................ Permit No.Zf�..--f/' (Complete in Triplicate) ................................... Al /D- This Permit Expires i 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'compliance with County Ordinance No 49 nd existing Rules and Regulations: JOB ADDRESS/LOCATION ....1.7lc?.7`.0.......... .. .. `,� ...._....... "- --.;L/.,.CENSUS TRACT ._...... .::-Owner's Name ... C...._ -•--•. ......... . _ .. ---+.... Phone.� ��"�a��Gl__r. Address _......:.. �:_ . . City 4-�V. .:........... .......... Contractor's Name .. G _► _: _. _... � -_""--. kens Phone ...............: � Aicense # �66� Installation will serve: Residence, Apartment House C] Commercial EjTrailer Court. 0- k f i Motel ❑ Other .................. :... ...................: . . . t r ,ice +�f� f.� i Number of living units:._..,...... Number.of;.bedr ms .�J,;j7arbage Grindr .._ .._ _. t Size ..... .. __ ... .. ......_.._Water Su I Public S stem and name ............. fit _ ��_�.4J4�►J-_. ..."PrivateCharacter of soil to a depth of 3 feet. Sand 0; Silt❑ ` ❑ Peat❑ Sandy Loam 0 Clay Loam t Hardpan Adobe Fill Material .......... :.- If,yes,: pe .............................. l (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 204 feet,) i PACKAGE TREATMENT. [ J SEPTIC TANK[ Size........:........................-•............... Liquid Depth -- ----.._........?_ Capacity ........:........... Type ................ . Material...-............. 'No.� Compartments ..... ............€. Distance to nearest: Well .. r. ... .Foundatiori .......... ....:... Prop. Line......._.......__... ...... = LEACHING LINE No. of Lin i � � � ...__.. Length of each line.------------------ Total Length, 'D' Box ...e5.._.. Type Filter'Materia pth "Filter Material Distance to nearest: Well ._ --------------------- Depth _ .-__ Foundation s u :. Property Line Rock Filled Yes No SEEPAGE PIT De th Diameter Number .::-_-• ❑ Water Table Depth ...........:.....;' # Rock Size _._.>.. ................ z , I Distance to nearest: Well ___:__.Foundation ._ Prop, Line .........._.._._.... .......----•--- Dat ..............._. ...•. REPAIR/ADi73TION{Frau. Sanitation.Permit�# ..._. .._ ..�_....-•�•------------ -••_�_----•�.-....:---.>:.-___=-_._ .' j Septic Tank (Specify Requirements) .._..... -------....•.-••• . ibis osal Field (Specify equirements **��- - - --..�- ----!I -' . ......... .... -?-----N- a - .. .. ----- Draw existin nd re fired ddition on raver . t . .............. - ( g 5" side) i I 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-'Reguldtioni:of the Soni Joaquin Loital Health Diitrict.:Horiie owner orllcen1 sed agents signature certifies.the following: ... :.. .. z "I'certify that in the erformance of the work far whiahhis:permit is issued, 3 shall not employ any person in such manner9 `-- as to became subec to orknt�n•s:Coni a anon laCalifornia nnI p Signed __ tel. ..... f i BY •---•- --- -- - ---- . _.... ..._.._... .............:....------ -Ti le- .. :. t eerr than ow !! FOR DEPARTMENT USE ONLY BUILDING PERMIT,ISSUED ----------••-=•.. ...::..:.:.:..:..::.r..:::._...._:::.::.:::.::........:c."_:_---__: . -•=--DATE :�C1-r:'1..��.'.T7 ... APPLICATION ACCEPTED BY _ _ D ATE °. .. :_ ADDITIONAL COMMENTS ..............:. ... ....--......-........................ ..................................................................... ................_..--_.. ---_..._ .. ... ... ............ ....................E ........................'............,..........._..I..._ .. .. .. • - - _._ .. ... - .._._ -- ... . ...... ............................................ - ......_.........._..._.__.._..... ...... Final Inspection by: CA.... _ ' Dale ,1f7 ' SAN JOAQUiN LOCAL HEALTH DISTRICT J