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FOR OFFICE U5E.j t 7 -- - l ............. APPLICATION FOR _...........:......:................... R SANITATION PERMIT � • ..........:........... :...: , (Complete in Triplicate) Date Issued ._9 `f ........ This Permit Expires 1 Year From Dae issue ' Application is hereby mode'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 .:: --.+.%•� iZ IR rc' ( 14 11 4ATjli�`o CENSUS TRACT .-•-•-------- ......... ....... Name =T" t (fie l r ��, fib, --•-----------_ c: ., •-• ....................................... one .--..!'??..C' Address ..---•--..... M ..................................... - ---------- . ...............•-----••••-•--------,City --,._....._.......__.....-----••-- Contractor's Name .......91Z_ R G II ..License # 4•TAlg-. Ph 8z _ GS Installation will serve: Residence P Apartment House t3 Commercial❑Trailer Court 0 � Motel ❑Other----•-----=-= -- 1 Number of living - units:-..-- -._-•- Number of bedrooms '�'.._Garbage Grinder Lot Size �cke>4 ....................................... Water Supply: Public System and name , T - w 'A1-T-o- Private❑ E - -----------•--------•-----••--.._...._.-_-..._..._.......................................... t Character of soil to a depth of S feet: Sand Slit❑ Clay ❑ peat❑ Sandy Loam. ❑ Clay Loam D ' Hardpan 0 Adobe 0 Fill Material ............If yes,type............... ............ (Plot plan, showing size of lot, locution 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 [ 'r SEPTIC TAMC I l Size-................ Liquid Depth Capacity __- Type ---- Material.._.. ...... No. Compartments Distance.to near - Well ...............:....•.. Foundation __ Prop. Line LEACHING LINE [ ] No. of Lines - _-•- Length ach line--------------------------.. Total length 'D' Box ............ Type .Filter real ....................Depth .Filter Material ..................... ................. re to nearest: W -----------__ _________ Foundation -- Property Lina in SEEPAGE PIT [ ) Depth .........:..... Diameter Number ........_-.--........-----__ {tock Filled Yes ❑ No (3 . Water To ..Boric Size epth .... -------- ------------.............------- Distan a to nearest: Well ..... dation •---...------•..................... •-----..-_ ....... Prop. Line ............----•_.... REPAIR/ADDITION Prev. Sanitation Permitil` bate( ---•••........_ --•--_--.•.................. ..) 3 Septic Tank (Specify Requirements) -------------- .............................. ...........................•--•...-----................. ..... Disposal Field (Specify Requirements) A c3 o r t L U .. ._ .......................................... ----------.................. --------------- ....-._...•. ------ ------------ ----------- —----- ------ •-------- -•---•------•--••- (Draw existing and required addition on reverse side) 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 Rales and Regulations of the San Joaquin local Heahh:District. Home owner or Ileen- 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 become subject to Workman's Compensation laws of California.,, Signed ------ Owner ' -•-- •.,((��By ''?-..-.... �P----••--------- .......... yitle ...... .. .... giber tba owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 8Y :.�...,.._, �'1rvM'�--• .... DATE - `- 1" -- ----- :7� ILDING PERMIT ISSUED ------.-,.-------------- .... ©ATE ...................... L�6ITIOLV9L�QISAM€ -------- -•--•------•--------------------_ .............. •..---••-- . --------------------------•-------.....----.............. ----- ------------ ------ •-- ----- 1 s-----------•.by: _ --------- •-•------------------------------------•---..,--------.-.-.-....----• -'-------- ----------------- Final Inpection by: .. - ............... •-•----------------•---------..-.__....-- ........................... . _. - .... -----------Date .................... .-..... EH 13 2L 1-6 Ov. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M - k