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FOR OFFICE USE: - 46- APPLICATION FOR SANITATION PERMIT . . . . .... . . ............................._... (Complete in Triplicate) Permit No. .. Date Issued - (/ -_ This Permit Expires 1 Year From Date Issued pplication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein aescribed. This application is made in compliance with County Ordinance No, 549 and existing Rules and Regulations: / Ltd isICA�rGlcr �/.t(` �� ,c �r`� CENSUS TRACT ---.._ JOB ADDRESS/LOCATION .... Owner's Name L/-�. t '+ '�f/rh 51Zofwi.. `•��.'........ ..................... ..Phone .... . .�/� ......._..... Address /G' 347--4/D .�C !-G'? tsdi�. .... Q,..........•........._........City . ... ...................................... ( !fit/d /. License '..`��7✓?..... Phone ¢ 3/S/y Contractor's Name .. _ .................... Installation will serve: Residence❑Apartment House❑ Commercial (-,Trailer Court (] Motel ❑Other ?, Number of living units: Ncmber of bedrooms ...........Garbage Grinder Lot Size ��_,-11 40•••...-----•••••• Water Supply: Public System and name . .__ Private Character of soil to a depth of 3 feet: Sand ❑ Silt Clay ❑ Peat❑ Sandy Loomo Clay Loam ❑ Hardpan %1 Adobe r 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 seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( ' SEPTIC TANK [ 1 �4'Size.=s =.,.'�/. �`� Liquid Depth . ..........._ It�'•1. Capacity Q-a.....- Type . T Material.�tC No. Compartments -'.- distance to nearest: Wel! ,l04...........................Foundation D Prop. line . -- J LEACHING LINE K No. of Lires Length of each line ,On Total Length �Q._.-. .... 'D' Box o2 Type Filter Material',3y '" 7J ..Depth Filter Material - K'�•..••••••.••So•-•-•••••• � Distance to nearest: Well let?. . Foundation //,P �- Property Line ./•-....-............ (� SEEPAGE PIT I Depth Diameter . ....... Numbe, Rock Filled Yes ❑ No Q Water Table Depth .................. . ........._ ...Rock Size ............................ F Distance to nearest: Well ._ ..........................._......Foundation Prop. Line ............ ......... REPAIR/ADDITION(Prev. Sanitation Permit# ........ .-..._.............,......_--- Date .................................) Septic Tank (Specify Requirements} ..............._........................... ....................................._............. ........._..._._.. P DisposalField ISpecify Requirements) ........................................................................._.................. ..........._....................._..._. .._.....---•..........................--•-••........................._..........................._..................................................---...... -- ------------ - ------- ...................... .....-------•... ...... _ ...................... (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 Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- 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 becgme subject to Workman's Compensation laws of California." Signed ._tU. r1a++. .'�. Gc. 'f....._. _,.,. Owner ! l� Title By �� .�.r�' ._Gtr/..- .... ..._.., - lif other than owner) ; FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .%��/- Ci ---:` ..................... ... ........... DATE .................... BUILDING PERMIT ISSUED DATE . _............ ...................... �.he. .i�Y.✓7,�C .__.l3 it R ..-.....I ....................... �DITIONAL COMMENTS •�� ..a_>! - ••--•--•---•--•••-•-•-- ..........................................................................................................._..............................-.._..................._........... Final Inspection by: /�- !�.-.� .......................I.........I..... . .....................................Date .. ,Jf' � .............. ..... SAN JOAQUIN LOCAL HEALTH DISTRICT r W 0 1.'AR tlav FAA