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nFOR OFFICE USE: APPLICATION. FOR SANITATION PERMIT _ ` (Complete in Triplicate! Permit No. . ..`.... This Permit expires 1 Year From Date issued Date Issued '7S 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. 5,49 and existing Rules and Re ulations: t .JOB ADDRESSJLOCATION .. - g . ---- ..................c Owner's Nary . I:NSUS T •-- --- RACT .... Address .................•--....-. Phone 9 .. . - ...__. . _ _ ---�-• _.... ---•----- ................city ....� • •• Contractor's Name .. e ? ................................ ------•---- . - License t Phone .. a,7 Installation will serve: Residence dfAportment House{] Commercial oTrailer Court �] Motel ❑Other.....__ .............. -• Number of living units:__._ .--•--- Number of bedrooms _. Garbage Grinder ...._....._. Lot Size _.....-_--•-• Water Supply. Public System and name .. pP y= r .... _ ........ .......... 4 Character of soil to " . "' . . ............I.. .Private a depth of 3 feet- Sand❑ Silt❑ Clay Q Peat❑ Sandy Loam Cj .Clay loam Hardpan 0 Adobe& Fill Material ............ if yes,type (Plot pian, showing size cf lot, locat#on of system In relation.to wells, NEW INSTALLATION: buildings, etc, must be planed on reverse side.) (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT j ] SEPTIC TANK Siae_....,_ Liquid Depth Capacity -----------------__ Type .:---- Material:_.:.. ---_ No. ------------- Compartments F y . Distance to nearest- Well ••.................... x� t --•---••._.--•-•-•••---...--•-__.....Foundation Prop. Line LEACHING LINE ---••------••--•---•-• Pro f ..................P No.--of Lines ........................ Length of each line............................ Total Length ........................ f 'D' Box ........_... Type Fitter Material Filter Material.............. De p , ................� { Distance to nearest: Weil�....._.__-- 4 i ........... foundation ____________ ...... Property Line SEEPAGE PIT -- [ { Depth .........:.. ...... Diameter -_-. Number � �... Rock Water Table Depth = r F fitted Y s ❑ No ------•--•--•-----•............... Rock Size .............=� ......... e Distante'to nearest: Well ' r ._......----•••---...---•-..._.. Foundation ........ .................... Prop. Line RtePAtRJADDtT10111(prev. Sanitation. Per # ................... ---••---•- ... •--•--------••----- - Date Septic Tank (Specify Requirements) ---4.flC .--- _--- • ............ Disposal Field (Specify ..........,,.....�. . ( p Y Requirements! ,�. cccr,.�... ` .,✓ .....----•-...._.. ............... . • --- --- - / c? �• .c (Draw existing and required oddit non.reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin r County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health:District. Hom sed agents signature certifies the following: s owner or ltcen: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become su ect to Wa m Is Compensation lo rsof Ca ia." Signed ............. 4t -d ._ o + i (If other than owner) ----- Title- ---.- ... an - FOR DEPARTM T ISE ONLY APPLICATION .ACCEPTED BY BUILDING PERMIT ISSUED ,l D ..... ----•-------•-•------------- ---..DATE --- <: _. ..._._.•._... __:..:_ ADDITIONAL COMMENTS ..........._=r_....-------••--- .-------- _DATE _ --------•- ---- ---•---_..._.._...--••----•- •------- Final Inspection by. ......... ... . . .... . -;.V Efi 1� 2tt 1-6f3 } v. ` .`P---._.... -- ---- ...Date ...... SAN JOAQ N LOCAL HEALTH DISTRICT "p e/7h 3M